Provider First Line Business Practice Location Address:
1205 W PRATT 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:
21223-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-332-8480
Provider Business Practice Location Address Fax Number:
410-625-4791
Provider Enumeration Date:
06/21/2006