Provider First Line Business Practice Location Address:
3635 OLD COURT RD
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-258-7655
Provider Business Practice Location Address Fax Number:
410-653-1942
Provider Enumeration Date:
10/13/2006