Provider First Line Business Practice Location Address:
1005 EASTERN AVE
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:
21202-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-547-9111
Provider Business Practice Location Address Fax Number:
410-547-0935
Provider Enumeration Date:
01/08/2007