Provider First Line Business Practice Location Address:
1300 YORK RD
Provider Second Line Business Practice Location Address:
BLDG A, SUITE 100
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-296-5863
Provider Business Practice Location Address Fax Number:
410-296-3105
Provider Enumeration Date:
11/26/2007