Provider First Line Business Practice Location Address:
6535 NORTH CHARLES STREET
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-7417
Provider Business Practice Location Address Fax Number:
410-828-4695
Provider Enumeration Date:
03/24/2008