Provider First Line Business Practice Location Address:
107 W SARATOGA ST
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:
21201-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-539-1155
Provider Business Practice Location Address Fax Number:
410-685-5108
Provider Enumeration Date:
11/07/2006