Provider First Line Business Practice Location Address:
5610 HARFORD RD 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:
21214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-357-1869
Provider Business Practice Location Address Fax Number:
410-927-8158
Provider Enumeration Date:
08/21/2018