Provider First Line Business Practice Location Address:
1223 W CROSS 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:
21230-2336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-359-1801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2026