Provider First Line Business Practice Location Address:
1118 WARD 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:
21230-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-706-6412
Provider Business Practice Location Address Fax Number:
410-706-6426
Provider Enumeration Date:
04/29/2024