Provider First Line Business Practice Location Address:
301 ST PAUL PLACE
Provider Second Line Business Practice Location Address:
BURK BLDG STE 310
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-9752
Provider Business Practice Location Address Fax Number:
410-332-0626
Provider Enumeration Date:
06/30/2006