Provider First Line Business Practice Location Address:
5522 HARFORD RD
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:
21214-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-254-0202
Provider Business Practice Location Address Fax Number:
410-254-3912
Provider Enumeration Date:
11/02/2006