Provider First Line Business Practice Location Address:
1001 E FAYETTE 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:
21202-4715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-396-4387
Provider Business Practice Location Address Fax Number:
410-396-1617
Provider Enumeration Date:
12/14/2011