Provider First Line Business Practice Location Address:
685 W BALTIMORE ST
Provider Second Line Business Practice Location Address:
RM 480
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-939-6867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2007