Provider First Line Business Practice Location Address:
413 W SARATOGA ST STE 1
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:
21201-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-858-9782
Provider Business Practice Location Address Fax Number:
443-438-7407
Provider Enumeration Date:
09/12/2023