Provider First Line Business Practice Location Address:
1120 ST. PAUL ST.
Provider Second Line Business Practice Location Address:
GROUND LEVEL
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-685-7790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2012