Provider First Line Business Practice Location Address:
6565 N CHARLES ST STE 212
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:
21204-5805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-823-1120
Provider Business Practice Location Address Fax Number:
410-296-9009
Provider Enumeration Date:
06/24/2005