Provider First Line Business Practice Location Address:
2439 E LAFAYETTE 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:
21213-2562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-530-6612
Provider Business Practice Location Address Fax Number:
410-747-4076
Provider Enumeration Date:
03/31/2021