Provider First Line Business Practice Location Address:
9110 PHILADELPHIA RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-682-8700
Provider Business Practice Location Address Fax Number:
410-682-6155
Provider Enumeration Date:
10/11/2005