Provider First Line Business Practice Location Address:
219 W 29TH 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:
21211-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-880-1164
Provider Business Practice Location Address Fax Number:
667-285-8183
Provider Enumeration Date:
12/10/2010