Provider First Line Business Practice Location Address:
1404 W BALTIMORE 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:
21223-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-800-2121
Provider Business Practice Location Address Fax Number:
443-478-4716
Provider Enumeration Date:
01/11/2019