Provider First Line Business Practice Location Address:
1212 YORK RD
Provider Second Line Business Practice Location Address:
SUITE A201
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-337-7755
Provider Business Practice Location Address Fax Number:
410-337-7922
Provider Enumeration Date:
10/25/2005