Provider First Line Business Practice Location Address:
2637-39 GREENMOUNT AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-908-1113
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2023