Provider First Line Business Practice Location Address:
326 S. BROADWAY
Provider Second Line Business Practice Location Address:
1ST FLOOR REAR OFFICE
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-955-4444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2012