Provider First Line Business Practice Location Address:
6569 NORTH CHARLES STREET
Provider Second Line Business Practice Location Address:
SUITE 702
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:
410-828-5420
Provider Business Practice Location Address Fax Number:
410-821-5833
Provider Enumeration Date:
10/27/2006