Provider First Line Business Practice Location Address:
1400 ANGLESEA STREET
Provider Second Line Business Practice Location Address:
APT 1B
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-800-6410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2012