Provider First Line Business Practice Location Address:
649 WASHINGTON BLVD
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:
21230-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-576-0312
Provider Business Practice Location Address Fax Number:
410-576-2310
Provider Enumeration Date:
08/13/2008