Provider First Line Business Practice Location Address:
1205 YORK RD STE 21
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:
21093-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-6062
Provider Business Practice Location Address Fax Number:
410-298-8225
Provider Enumeration Date:
10/11/2007