Provider First Line Business Practice Location Address:
8222 GUILFORD 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:
21202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-549-7237
Provider Business Practice Location Address Fax Number:
314-549-7254
Provider Enumeration Date:
05/18/2026