Provider First Line Business Practice Location Address:
1645 E BALTIMORE 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:
21231-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-563-2500
Provider Business Practice Location Address Fax Number:
410-732-8871
Provider Enumeration Date:
07/15/2006