Provider First Line Business Practice Location Address:
701 W PRATT ST RM 474
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:
21201-1023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-6325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2014