Provider First Line Business Practice Location Address:
6112 YORK RD
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:
21212-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-846-0240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2024