Provider First Line Business Practice Location Address:
4367 HOLLINS FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 4A
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-242-6220
Provider Business Practice Location Address Fax Number:
410-242-6731
Provider Enumeration Date:
08/04/2006