Provider First Line Business Practice Location Address:
3700 KOPPERS ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-525-9300
Provider Business Practice Location Address Fax Number:
410-525-0596
Provider Enumeration Date:
11/15/2006