Provider First Line Business Practice Location Address:
2915 E FEDERAL 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:
21213-3909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-393-1193
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2021