Provider First Line Business Practice Location Address:
2216 N CALVERT 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:
21218-5886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-2436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2011