Provider First Line Business Practice Location Address:
518 N. CHARLES ST 2ND FLR REAR
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:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-208-2645
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2022