Provider First Line Business Practice Location Address:
1501 W SARATOGA 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:
21223-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-383-7197
Provider Business Practice Location Address Fax Number:
410-735-5267
Provider Enumeration Date:
06/27/2017