Provider First Line Business Practice Location Address:
655 W BALTIMORE ST
Provider Second Line Business Practice Location Address:
ROOM 14-011
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-706-1413
Provider Business Practice Location Address Fax Number:
410-706-1414
Provider Enumeration Date:
04/11/2006