Provider First Line Business Practice Location Address:
2800 KIRK 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:
21218-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-467-7140
Provider Business Practice Location Address Fax Number:
410-467-7141
Provider Enumeration Date:
10/12/2019