Provider First Line Business Practice Location Address:
5209 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE B12
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-532-2476
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2014