Provider First Line Business Practice Location Address:
6212 YORK RD
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:
21212-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-374-3801
Provider Business Practice Location Address Fax Number:
410-755-7797
Provider Enumeration Date:
11/19/2020