Provider First Line Business Practice Location Address:
8307 PHILADELPHIA 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:
21237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-687-7700
Provider Business Practice Location Address Fax Number:
410-687-7702
Provider Enumeration Date:
08/27/2006