Provider First Line Business Practice Location Address:
3219 PHELPS LANE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-302-2177
Provider Business Practice Location Address Fax Number:
410-488-1144
Provider Enumeration Date:
04/28/2017