Provider First Line Business Practice Location Address:
1205 YORK RD STE 22
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:
21093-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-832-3828
Provider Business Practice Location Address Fax Number:
410-372-3937
Provider Enumeration Date:
01/23/2026