Provider First Line Business Practice Location Address:
821 N EUTAW ST
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-530-8764
Provider Business Practice Location Address Fax Number:
877-335-6202
Provider Enumeration Date:
12/27/2009