Provider First Line Business Practice Location Address:
1501 DIVISION 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:
21217-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-728-5522
Provider Business Practice Location Address Fax Number:
410-728-6181
Provider Enumeration Date:
02/28/2008