Provider First Line Business Practice Location Address:
419 W REDWOOD ST
Provider Second Line Business Practice Location Address:
SUITE 520
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-2250
Provider Business Practice Location Address Fax Number:
410-328-8225
Provider Enumeration Date:
03/17/2010