Provider First Line Business Practice Location Address:
3400 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:
21218-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-516-7752
Provider Business Practice Location Address Fax Number:
410-516-6440
Provider Enumeration Date:
10/28/2016