Provider First Line Business Practice Location Address:
6101 PARK HEIGHTS AVE APT 1D
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:
21215-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-624-7190
Provider Business Practice Location Address Fax Number:
410-624-7193
Provider Enumeration Date:
12/23/2024