Provider First Line Business Practice Location Address:
351 W CAMDEN 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:
21201-7912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-328-6120
Provider Business Practice Location Address Fax Number:
410-328-1674
Provider Enumeration Date:
04/10/2017