Provider First Line Business Practice Location Address:
2225 N CHARLES STEET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-366-4360
Provider Business Practice Location Address Fax Number:
410-243-7948
Provider Enumeration Date:
04/21/2009