Provider First Line Business Practice Location Address:
2700 WASHINGTON 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:
21211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-270-4235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2018