Provider First Line Business Practice Location Address:
3655 A OLD COURT ROAD
Provider Second Line Business Practice Location Address:
SUITE # 10
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-484-3709
Provider Business Practice Location Address Fax Number:
410-484-0580
Provider Enumeration Date:
10/31/2006