Provider First Line Business Practice Location Address:
2401 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:
21223-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-383-4908
Provider Business Practice Location Address Fax Number:
410-669-5179
Provider Enumeration Date:
12/05/2005