Provider First Line Business Practice Location Address:
2530 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-889-7872
Provider Business Practice Location Address Fax Number:
410-889-7992
Provider Enumeration Date:
03/29/2007