Provider First Line Business Practice Location Address:
1606 LIGHT 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:
21230-4917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-384-3193
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2023