Provider First Line Business Practice Location Address:
5623 REISTERSTOWN RD STE 1
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:
21215-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-949-2919
Provider Business Practice Location Address Fax Number:
410-630-5561
Provider Enumeration Date:
07/17/2007