Provider First Line Business Practice Location Address:
2616 ERDMAN AVE
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:
21213-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-857-6610
Provider Business Practice Location Address Fax Number:
410-439-9604
Provider Enumeration Date:
08/17/2026