Provider First Line Business Practice Location Address:
3218 GREENMOUNT AVENUE
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:
21218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-515-4868
Provider Business Practice Location Address Fax Number:
410-275-0466
Provider Enumeration Date:
01/28/2026