Provider First Line Business Practice Location Address:
6569 N CHARLES ST STE 700
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:
21204-6832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-8535
Provider Business Practice Location Address Fax Number:
410-828-4005
Provider Enumeration Date:
10/23/2007