Provider First Line Business Practice Location Address:
6565 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-321-1195
Provider Business Practice Location Address Fax Number:
410-321-1197
Provider Enumeration Date:
11/28/2006