Provider First Line Business Practice Location Address:
511 W PRATT ST
Provider Second Line Business Practice Location Address:
2004
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-539-2461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2010