Provider First Line Business Practice Location Address:
601 SCOTT ST
Provider Second Line Business Practice Location Address:
SUITE 1F
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-837-0037
Provider Business Practice Location Address Fax Number:
410-837-1156
Provider Enumeration Date:
07/13/2007