Provider First Line Business Practice Location Address:
6920 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:
21234-7712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-319-9161
Provider Business Practice Location Address Fax Number:
410-319-9162
Provider Enumeration Date:
04/16/2007