Provider First Line Business Practice Location Address:
711 W. 40TH STREET
Provider Second Line Business Practice Location Address:
SUITE 321
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-2882
Provider Business Practice Location Address Fax Number:
410-235-2883
Provider Enumeration Date:
05/31/2016