Provider First Line Business Practice Location Address:
2116 W PRATT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-233-3323
Provider Business Practice Location Address Fax Number:
410-233-1775
Provider Enumeration Date:
03/14/2006