Provider First Line Business Practice Location Address:
2435 SAINT PAUL ST
Provider Second Line Business Practice Location Address:
C/O KIDADA FIELDS
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-407-3416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2010