Provider First Line Business Practice Location Address:
1212 YORK RD STE A101
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:
21093-6240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-394-0520
Provider Business Practice Location Address Fax Number:
443-394-0524
Provider Enumeration Date:
04/23/2007