Provider First Line Business Practice Location Address:
3900 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-235-1233
Provider Business Practice Location Address Fax Number:
410-235-1286
Provider Enumeration Date:
07/17/2006