Provider First Line Business Practice Location Address:
6535 N CHARLES STREET
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BALTO
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:
410-938-5252
Provider Business Practice Location Address Fax Number:
410-938-5250
Provider Enumeration Date:
09/01/2006