Provider First Line Business Practice Location Address:
821 NORTH EUTAW STREET
Provider Second Line Business Practice Location Address:
RM 208
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-669-3313
Provider Business Practice Location Address Fax Number:
410-669-1301
Provider Enumeration Date:
01/22/2007