Provider First Line Business Practice Location Address:
1034 MCDONOGH 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:
21205-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-999-1742
Provider Business Practice Location Address Fax Number:
410-999-1742
Provider Enumeration Date:
12/03/2020