Provider First Line Business Practice Location Address:
3333 N CALVERT ST
Provider Second Line Business Practice Location Address:
SUITE 605, JOHNSTON PROF. BLDG.
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-889-8899
Provider Business Practice Location Address Fax Number:
410-889-7924
Provider Enumeration Date:
10/26/2007