Provider First Line Business Practice Location Address:
837 WASHINGTON BLVD, SUITE 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:
21230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-298-8046
Provider Business Practice Location Address Fax Number:
410-496-4153
Provider Enumeration Date:
03/12/2020