Provider First Line Business Practice Location Address:
1001 W PRATT 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:
21223-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-752-8787
Provider Business Practice Location Address Fax Number:
410-752-8797
Provider Enumeration Date:
02/20/2007