Provider First Line Business Practice Location Address:
200 WEST SARATOGA ST.
Provider Second Line Business Practice Location Address:
6306 1/2 YORK RD
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-685-0733
Provider Business Practice Location Address Fax Number:
410-685-3820
Provider Enumeration Date:
07/14/2006