Provider First Line Business Practice Location Address:
1435 S HANOVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-4438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-752-2475
Provider Business Practice Location Address Fax Number:
410-385-1466
Provider Enumeration Date:
11/09/2005