Provider First Line Business Practice Location Address:
316 N FRANKLINTOWN RD
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:
21223-1041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-296-6211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2026