Provider First Line Business Practice Location Address:
1205 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-821-6260
Provider Business Practice Location Address Fax Number:
410-296-6936
Provider Enumeration Date:
07/16/2006