Provider First Line Business Practice Location Address:
5411 OLD FREDERICK ROAD
Provider Second Line Business Practice Location Address:
SUITE 18
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21229-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-744-7900
Provider Business Practice Location Address Fax Number:
410-744-0091
Provider Enumeration Date:
10/22/2021