Provider First Line Business Practice Location Address:
6401 YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-887-2243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006