Provider First Line Business Practice Location Address:
2145 YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-252-4217
Provider Business Practice Location Address Fax Number:
410-252-5529
Provider Enumeration Date:
07/09/2006