Provider First Line Business Practice Location Address:
2301 N ELLAMONT ST
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:
21216-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-831-8299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2020