Provider First Line Business Practice Location Address:
7801 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-823-2626
Provider Business Practice Location Address Fax Number:
410-823-7611
Provider Enumeration Date:
12/29/2007