Provider First Line Business Practice Location Address:
1734 YORK RD DEPT OF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTHERVILLE TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-5606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-252-2273
Provider Business Practice Location Address Fax Number:
410-561-3275
Provider Enumeration Date:
05/09/2007