Provider First Line Business Practice Location Address:
3655 OLD COURT RD
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-484-7780
Provider Business Practice Location Address Fax Number:
410-653-9415
Provider Enumeration Date:
06/20/2007