Provider First Line Business Practice Location Address:
1515 W. NORTH AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-396-0186
Provider Business Practice Location Address Fax Number:
410-545-1540
Provider Enumeration Date:
01/23/2017