Provider First Line Business Practice Location Address:
3411 CARLISLE AVE
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:
21216-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-929-5794
Provider Business Practice Location Address Fax Number:
410-413-7006
Provider Enumeration Date:
02/11/2026