Provider First Line Business Practice Location Address:
4300 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:
21212-4817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-552-1607
Provider Business Practice Location Address Fax Number:
443-552-1585
Provider Enumeration Date:
05/04/2026