Provider First Line Business Practice Location Address:
1650 ORLEANS ST
Provider Second Line Business Practice Location Address:
CRB I BUILDING, 3RD FLOOR, ROOM 307
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-955-2548
Provider Business Practice Location Address Fax Number:
410-955-8897
Provider Enumeration Date:
06/21/2010