Provider First Line Business Practice Location Address:
4136 E JOPPA RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-2286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-256-2930
Provider Business Practice Location Address Fax Number:
410-256-6020
Provider Enumeration Date:
12/06/2006