Provider First Line Business Practice Location Address:
650 W BALTIMORE ST
Provider Second Line Business Practice Location Address:
ROOM 4214, 4TH FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-706-7152
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2011