Provider First Line Business Practice Location Address:
1001 W PRATT 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:
21223-2679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-962-7180
Provider Business Practice Location Address Fax Number:
410-962-7194
Provider Enumeration Date:
10/19/2012