Provider First Line Business Practice Location Address:
2225 N CHARLES ST
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:
21218-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-366-0334
Provider Business Practice Location Address Fax Number:
410-366-2160
Provider Enumeration Date:
02/12/2007