Provider First Line Business Practice Location Address:
1210 EDISON HWY
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:
21213-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-559-2150
Provider Business Practice Location Address Fax Number:
667-303-3000
Provider Enumeration Date:
07/21/2019