Provider First Line Business Practice Location Address:
4705 HARFORD RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21214-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-444-0779
Provider Business Practice Location Address Fax Number:
410-444-0669
Provider Enumeration Date:
07/05/2007