Provider First Line Business Practice Location Address:
423 E NORTH 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:
21202-5915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-385-3188
Provider Business Practice Location Address Fax Number:
410-385-2154
Provider Enumeration Date:
08/02/2017