Provider First Line Business Practice Location Address:
6217 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:
21214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-444-5245
Provider Business Practice Location Address Fax Number:
410-426-3172
Provider Enumeration Date:
09/21/2006