Provider First Line Business Practice Location Address:
1585 SULPHUR SPRING RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-247-1100
Provider Business Practice Location Address Fax Number:
410-247-5740
Provider Enumeration Date:
10/03/2006