Provider First Line Business Practice Location Address:
2041 E MONUMENT ST
Provider Second Line Business Practice Location Address:
IMMUNOGENETICS LABORATORY
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21205-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-614-8978
Provider Business Practice Location Address Fax Number:
410-955-0431
Provider Enumeration Date:
11/02/2006