Provider First Line Business Practice Location Address:
1840 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-252-4015
Provider Business Practice Location Address Fax Number:
410-252-7410
Provider Enumeration Date:
08/06/2008