Provider First Line Business Practice Location Address:
1205 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE #39
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:
410-296-3113
Provider Business Practice Location Address Fax Number:
410-296-6170
Provider Enumeration Date:
11/14/2006