Provider First Line Business Practice Location Address:
1114 N CALVERT 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:
21202-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-869-5867
Provider Business Practice Location Address Fax Number:
443-885-9148
Provider Enumeration Date:
10/28/2019