Provider First Line Business Practice Location Address:
9616 HARFORD RD
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:
21234-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-663-7957
Provider Business Practice Location Address Fax Number:
410-663-6953
Provider Enumeration Date:
01/05/2012