Provider First Line Business Practice Location Address:
2000 W BALTIMORE ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21223-1558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-998-3920
Provider Business Practice Location Address Fax Number:
410-998-3931
Provider Enumeration Date:
09/22/2011