Provider First Line Business Practice Location Address:
1212 E 25TH ST
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:
21218-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-868-4189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2023