Provider First Line Business Practice Location Address:
2506 SAINT PAUL STREET
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:
21218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-3300
Provider Business Practice Location Address Fax Number:
410-366-1260
Provider Enumeration Date:
08/30/2005