Provider First Line Business Practice Location Address:
10153 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
COCKEYSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-628-2808
Provider Business Practice Location Address Fax Number:
410-628-2818
Provider Enumeration Date:
09/19/2006