Provider First Line Business Practice Location Address:
805 E FAYETTE ST
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:
21202-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-576-8300
Provider Business Practice Location Address Fax Number:
410-576-8385
Provider Enumeration Date:
05/19/2010