Provider First Line Business Practice Location Address:
7215 YORK RD
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:
21212-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-296-2272
Provider Business Practice Location Address Fax Number:
410-296-2394
Provider Enumeration Date:
04/09/2007