Provider First Line Business Practice Location Address:
301 SAINT PAUL PL
Provider Second Line Business Practice Location Address:
PHYS. OFFICE BLDG., SUITE 409
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-8484
Provider Business Practice Location Address Fax Number:
410-332-0600
Provider Enumeration Date:
06/09/2006