Provider First Line Business Practice Location Address:
6401 YORK RD STE 3
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:
21212-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-887-2754
Provider Business Practice Location Address Fax Number:
410-887-4820
Provider Enumeration Date:
08/08/2011