Provider First Line Business Practice Location Address:
8713 HARFORD ROAD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-665-1990
Provider Business Practice Location Address Fax Number:
410-665-9980
Provider Enumeration Date:
08/31/2006