Provider First Line Business Practice Location Address:
834 WOODWARD 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:
21230-2514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-418-5478
Provider Business Practice Location Address Fax Number:
410-727-1165
Provider Enumeration Date:
05/17/2010