Provider First Line Business Practice Location Address:
3701 N. CHARLES ST.
Provider Second Line Business Practice Location Address:
SUITE #1630
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:
410-347-1891
Provider Business Practice Location Address Fax Number:
410-347-1893
Provider Enumeration Date:
06/02/2006