Provider First Line Business Practice Location Address:
10 E 31ST 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:
21218-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-243-3035
Provider Business Practice Location Address Fax Number:
410-243-7253
Provider Enumeration Date:
10/18/2006