Provider First Line Business Practice Location Address:
5845 YORK RD
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:
21212-3613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-323-1515
Provider Business Practice Location Address Fax Number:
410-323-1784
Provider Enumeration Date:
02/02/2021