Provider First Line Business Practice Location Address:
2323 ORLEANS 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:
21224-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-558-4747
Provider Business Practice Location Address Fax Number:
410-732-0185
Provider Enumeration Date:
02/03/2012