Provider First Line Business Practice Location Address:
13801 YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCKEYSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21030-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-527-1900
Provider Business Practice Location Address Fax Number:
410-527-3516
Provider Enumeration Date:
11/29/2005