Provider First Line Business Practice Location Address:
500 WOODBOURNE 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:
21212-4244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-486-1238
Provider Business Practice Location Address Fax Number:
240-486-1238
Provider Enumeration Date:
12/25/2017