Provider First Line Business Practice Location Address:
51 N DUNDALK 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:
21222-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-558-7163
Provider Business Practice Location Address Fax Number:
410-522-6060
Provider Enumeration Date:
02/17/2023