Provider First Line Business Practice Location Address:
633 N AISQUITH 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:
21202-5375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-893-4600
Provider Business Practice Location Address Fax Number:
443-640-4358
Provider Enumeration Date:
01/22/2016