Provider First Line Business Practice Location Address:
5209 YORK RD
Provider Second Line Business Practice Location Address:
SUITE M-16, MAIL BOX B-16
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-323-5433
Provider Business Practice Location Address Fax Number:
410-435-5433
Provider Enumeration Date:
06/16/2009