Provider First Line Business Practice Location Address:
2310 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:
21218-5127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-844-4110
Provider Business Practice Location Address Fax Number:
410-741-3008
Provider Enumeration Date:
05/05/2016