Provider First Line Business Practice Location Address:
1503 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
JHU-SOM BOND STREET ANNEX SUITE 114
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21287-0018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-614-7196
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2005