Provider First Line Business Practice Location Address:
4502A N. CHARLES ST.
Provider Second Line Business Practice Location Address:
SHS
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-617-5030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2009