Provider First Line Business Practice Location Address:
924 E BALTIMORE 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:
21202-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-244-0783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007