Provider First Line Business Practice Location Address:
401 N BROADWAY ST
Provider Second Line Business Practice Location Address:
WEINBERG BLDG. RM. 2242
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21231-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-502-5160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2005