Provider First Line Business Practice Location Address:
1503 E. JEFFERSON STREET, RM 112
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:
21287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-502-6072
Provider Business Practice Location Address Fax Number:
410-502-1329
Provider Enumeration Date:
06/03/2006