Provider First Line Business Practice Location Address:
1205 YORK RD STE 39A
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:
21093-6219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-288-1870
Provider Business Practice Location Address Fax Number:
443-288-6639
Provider Enumeration Date:
04/27/2006