Provider First Line Business Practice Location Address:
1813 W SARATOGA 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:
21223-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-529-9938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2026