Provider First Line Business Practice Location Address:
60 N WOLFE STREET
Provider Second Line Business Practice Location Address:
CHILDREN'S CENTER BLOOMBERG 9411
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287-0005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-287-9870
Provider Business Practice Location Address Fax Number:
410-502-5400
Provider Enumeration Date:
06/17/2013