Provider First Line Business Practice Location Address:
809 1/2 MCHENRY 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:
21230-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-821-3485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2025