Provider First Line Business Practice Location Address:
4201 PRIMROSE AVENUE
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:
21215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-764-8560
Provider Business Practice Location Address Fax Number:
410-764-9114
Provider Enumeration Date:
06/30/2017