Provider First Line Business Practice Location Address:
1407 YORK RD STE 100A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-252-9090
Provider Business Practice Location Address Fax Number:
410-494-7064
Provider Enumeration Date:
10/11/2006