Provider First Line Business Practice Location Address:
1501 WEST SARATOGA 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:
21223-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-383-7194
Provider Business Practice Location Address Fax Number:
410-383-3131
Provider Enumeration Date:
03/28/2007