Provider First Line Business Practice Location Address:
6569 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-6831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-938-8960
Provider Business Practice Location Address Fax Number:
410-583-9770
Provider Enumeration Date:
08/25/2006