Provider First Line Business Practice Location Address:
600 LIGHT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21230-3856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-659-0900
Provider Business Practice Location Address Fax Number:
410-659-0902
Provider Enumeration Date:
08/31/2006