Provider First Line Business Practice Location Address:
2527 W 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:
21223-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-272-5675
Provider Business Practice Location Address Fax Number:
888-424-7594
Provider Enumeration Date:
03/25/2013