Provider First Line Business Practice Location Address:
200 E. NORTH AVENUE - ROOM 105: RE-ENGAGEMENT CENTER
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:
21202-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-642-4220
Provider Business Practice Location Address Fax Number:
410-244-8213
Provider Enumeration Date:
05/28/2019