Provider First Line Business Practice Location Address:
1120 N CHARLES ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-5592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-522-7746
Provider Business Practice Location Address Fax Number:
410-510-1844
Provider Enumeration Date:
02/13/2013