Provider First Line Business Practice Location Address:
1820 LANCASTER ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21231-3584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-929-1808
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2012