Provider First Line Business Practice Location Address:
6701 NORTH CHARLES STREET, GREAT BALTIMORE MEDICAL CENT
Provider Second Line Business Practice Location Address:
PPE SUITE 203
Provider Business Practice Location Address City Name:
BALTIMORE/TOWNSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-849-2688
Provider Business Practice Location Address Fax Number:
443-849-8138
Provider Enumeration Date:
04/16/2025