Provider First Line Business Practice Location Address:
200 E NORTH AVENUE
Provider Second Line Business Practice Location Address:
RELATED SERVICES ROOM 210
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:
443-642-4204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2019