Provider First Line Business Practice Location Address:
5820 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-3610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-433-0040
Provider Business Practice Location Address Fax Number:
410-630-1043
Provider Enumeration Date:
10/31/2006