Provider First Line Business Practice Location Address:
5535 HARFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21214-2233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-444-2770
Provider Business Practice Location Address Fax Number:
410-444-2772
Provider Enumeration Date:
10/21/2006