Provider First Line Business Practice Location Address:
2446 N CHARLES STREET
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:
21218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-805-9464
Provider Business Practice Location Address Fax Number:
810-413-5792
Provider Enumeration Date:
04/17/2016