Provider First Line Business Practice Location Address:
3107-3109 ERDMAN 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:
21213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-869-4602
Provider Business Practice Location Address Fax Number:
410-869-4603
Provider Enumeration Date:
05/22/2020