Provider First Line Business Practice Location Address:
610 N. CHESTER 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:
21205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-675-2125
Provider Business Practice Location Address Fax Number:
410-366-2855
Provider Enumeration Date:
03/30/2009