Provider First Line Business Practice Location Address:
801 WASHINGTON BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 1-A
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-685-5555
Provider Business Practice Location Address Fax Number:
410-685-0320
Provider Enumeration Date:
01/28/2006