Provider First Line Business Practice Location Address:
2043 MONDAWMIN MALL
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:
21215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-523-6315
Provider Business Practice Location Address Fax Number:
410-523-4796
Provider Enumeration Date:
09/10/2010