Provider First Line Business Practice Location Address: 
227 ST. PAUL PLACE
    Provider Second Line Business Practice Location Address: 
6TH FLOOR
    Provider Business Practice Location Address City Name: 
BALTIMORE
    Provider Business Practice Location Address State Name: 
MD
    Provider Business Practice Location Address Postal Code: 
21202-2102
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
410-332-9200
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/08/2007