Provider First Line Business Practice Location Address:
655 W BALTIMORE ST
Provider Second Line Business Practice Location Address:
11-047
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-3335
Provider Business Practice Location Address Fax Number:
410-328-5484
Provider Enumeration Date:
08/09/2006