Provider First Line Business Practice Location Address:
5900 YORK RD STE 206
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:
21212-3098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-627-8968
Provider Business Practice Location Address Fax Number:
202-677-7669
Provider Enumeration Date:
12/26/2024