Provider First Line Business Practice Location Address:
2203 N CHARLES ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-662-6000
Provider Business Practice Location Address Fax Number:
410-662-6001
Provider Enumeration Date:
11/08/2013