Provider First Line Business Practice Location Address:
5901 HOLABIRD AVE STE A
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:
21224-6015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-991-0645
Provider Business Practice Location Address Fax Number:
410-367-3321
Provider Enumeration Date:
04/22/2026