Provider First Line Business Practice Location Address:
413 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:
21201-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-858-9782
Provider Business Practice Location Address Fax Number:
410-833-5060
Provider Enumeration Date:
10/05/2023