Provider First Line Business Practice Location Address:
600 N WOLFE STREET
Provider Second Line Business Practice Location Address:
PHIPPS 554
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:
410-955-7851
Provider Business Practice Location Address Fax Number:
410-367-3255
Provider Enumeration Date:
05/13/2014