Provider First Line Business Practice Location Address:
144 7 YORK RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-339-5529
Provider Business Practice Location Address Fax Number:
410-339-5530
Provider Enumeration Date:
10/14/2005