Provider First Line Business Practice Location Address:
9613-I HARFORD ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-665-6200
Provider Business Practice Location Address Fax Number:
410-665-6323
Provider Enumeration Date:
12/19/2006