Provider First Line Business Practice Location Address:
1300 YORK RD BLDG B
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:
21093-6016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-356-9939
Provider Business Practice Location Address Fax Number:
410-356-9987
Provider Enumeration Date:
04/24/2026