Provider First Line Business Practice Location Address:
3108-3110 W NORTH 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:
21216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
667-310-9320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2026