Provider First Line Business Practice Location Address:
5718 HARFORD RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21214-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-254-3004
Provider Business Practice Location Address Fax Number:
410-254-3005
Provider Enumeration Date:
12/03/2007