Provider First Line Business Practice Location Address:
2637-39 GREENMOUNT AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-789-5556
Provider Business Practice Location Address Fax Number:
443-303-8041
Provider Enumeration Date:
07/09/2021