Provider First Line Business Practice Location Address:
1050 S NORTHPOINT ROAD
Provider Second Line Business Practice Location Address:
SUITE 204-205
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-285-0740
Provider Business Practice Location Address Fax Number:
410-282-5861
Provider Enumeration Date:
07/02/2007