Provider First Line Business Practice Location Address:
1300 YORK ROAD
Provider Second Line Business Practice Location Address:
BLDG. A SUITE 300
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-4629
Provider Business Practice Location Address Fax Number:
410-828-4783
Provider Enumeration Date:
05/04/2009