Provider First Line Business Practice Location Address:
1212 YORK RD
Provider Second Line Business Practice Location Address:
SUITE A 301
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-7154
Provider Business Practice Location Address Fax Number:
410-821-7154
Provider Enumeration Date:
07/28/2005