Provider First Line Business Practice Location Address:
208 E CHASE ST
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:
21202-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-547-1161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2009