Provider First Line Business Practice Location Address:
801 N WOODINGTON 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:
21229-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-204-1274
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2026