Provider First Line Business Practice Location Address:
5602 BALTIMORE NATIONAL PIKE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-747-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007