Provider First Line Business Practice Location Address:
2438 N CHARLES ST
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:
21218-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-708-0175
Provider Business Practice Location Address Fax Number:
443-708-4054
Provider Enumeration Date:
11/20/2012