Provider First Line Business Practice Location Address:
5900 YORK RD STE 206
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:
21212-3098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-489-0615
Provider Business Practice Location Address Fax Number:
202-379-9220
Provider Enumeration Date:
11/13/2020