Provider First Line Business Practice Location Address:
22 S. GREENE ST.
Provider Second Line Business Practice Location Address:
G8J42
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-9701
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2011