Provider First Line Business Practice Location Address:
741 MCHENRY 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:
21230-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-545-0935
Provider Business Practice Location Address Fax Number:
202-545-0934
Provider Enumeration Date:
09/04/2012