Provider First Line Business Practice Location Address:
4000 OLD COURT RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-2891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-415-0005
Provider Business Practice Location Address Fax Number:
410-415-0006
Provider Enumeration Date:
07/22/2008