Provider First Line Business Practice Location Address:
3804 LIBERTY 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:
21215-7119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-367-5151
Provider Business Practice Location Address Fax Number:
410-367-2718
Provider Enumeration Date:
08/03/2017