Provider First Line Business Practice Location Address:
27 N LAKEWOOD AVE
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:
21224-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-558-1230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2021