Provider First Line Business Practice Location Address:
1531 S EDGEWOOD ST STE B
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:
21227-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-800-4730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2020