Provider First Line Business Practice Location Address:
408 E EAGER ST
Provider Second Line Business Practice Location Address:
MOBILE VAN AT OPPOSITE STREET CURB
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21202-4215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-738-4731
Provider Business Practice Location Address Fax Number:
410-367-5879
Provider Enumeration Date:
06/26/2019