Provider First Line Business Practice Location Address:
1205 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-583-9206
Provider Business Practice Location Address Fax Number:
410-821-8639
Provider Enumeration Date:
01/31/2007