Provider First Line Business Practice Location Address:
4919 HARFORD 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:
21214-2984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-992-2299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2025