Provider First Line Business Practice Location Address:
5911 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-617-1200
Provider Business Practice Location Address Fax Number:
410-617-1203
Provider Enumeration Date:
05/02/2007