Provider First Line Business Practice Location Address:
1501 E 33RD STREET
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:
21218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-243-3714
Provider Business Practice Location Address Fax Number:
410-338-0977
Provider Enumeration Date:
10/26/2006