Provider First Line Business Practice Location Address:
29 S PACA ST
Provider Second Line Business Practice Location Address:
LL, RM 12
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-6789
Provider Business Practice Location Address Fax Number:
410-328-8726
Provider Enumeration Date:
01/13/2012