Provider First Line Business Practice Location Address:
5224 HARFORD RD STE B
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:
21214-2694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-303-9229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2019