Provider First Line Business Practice Location Address:
4432 PARK HEIGHTS 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:
21215-6315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-728-4491
Provider Business Practice Location Address Fax Number:
410-728-5729
Provider Enumeration Date:
10/15/2018