Provider First Line Business Practice Location Address:
3505 WHITE CHAPEL 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:
21215-7331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-926-1380
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2026