Provider First Line Business Practice Location Address:
9110 PHILADELPHIA ROAD
Provider Second Line Business Practice Location Address:
SUITE214
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-780-0120
Provider Business Practice Location Address Fax Number:
410-780-0702
Provider Enumeration Date:
02/18/2009