Provider First Line Business Practice Location Address:
110 S PACA ST
Provider Second Line Business Practice Location Address:
SUITE 200
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:
410-328-6332
Provider Business Practice Location Address Fax Number:
410-328-8028
Provider Enumeration Date:
03/31/2015