Provider First Line Business Practice Location Address:
6501 N CHARLES STREET
Provider Second Line Business Practice Location Address:
ATTENTION: MANAGED CARE CREDENTIALING
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-6819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-938-5000
Provider Business Practice Location Address Fax Number:
443-420-9454
Provider Enumeration Date:
06/27/2023