Provider First Line Business Practice Location Address:
6105 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:
21214-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-254-5437
Provider Business Practice Location Address Fax Number:
410-254-5310
Provider Enumeration Date:
04/20/2007