Provider First Line Business Practice Location Address:
5300 HOLABIRD AVE STE A-1
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:
21224-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-288-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2019