Provider First Line Business Practice Location Address:
8035 HARFORD RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234-5848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-661-7200
Provider Business Practice Location Address Fax Number:
410-665-3713
Provider Enumeration Date:
11/03/2010