Provider First Line Business Practice Location Address:
2326 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-2266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-5699
Provider Business Practice Location Address Fax Number:
410-828-0711
Provider Enumeration Date:
10/18/2006