Provider First Line Business Practice Location Address:
600 N WOLFE STREET
Provider Second Line Business Practice Location Address:
PHIPPS 455D
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-955-7481
Provider Business Practice Location Address Fax Number:
410-614-7903
Provider Enumeration Date:
07/09/2012