Provider First Line Business Practice Location Address:
1935 W PRATT 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:
21223-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-449-6919
Provider Business Practice Location Address Fax Number:
443-388-8112
Provider Enumeration Date:
03/19/2025