Provider First Line Business Practice Location Address:
4000 W NORTHERN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-4473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-578-1490
Provider Business Practice Location Address Fax Number:
410-578-1492
Provider Enumeration Date:
12/12/2006