Provider First Line Business Practice Location Address:
9114 PHILADELPHIA RD
Provider Second Line Business Practice Location Address:
SUITE 106 - 108
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-918-0777
Provider Business Practice Location Address Fax Number:
410-369-1707
Provider Enumeration Date:
12/29/2005