Provider First Line Business Practice Location Address:
2115 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:
21218-5760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-441-7536
Provider Business Practice Location Address Fax Number:
443-449-5651
Provider Enumeration Date:
11/22/2022