Provider First Line Business Practice Location Address:
6401 YORK RD
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-2152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-887-3708
Provider Business Practice Location Address Fax Number:
410-377-9687
Provider Enumeration Date:
03/23/2007