Provider First Line Business Practice Location Address:
8923 OLD 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:
21234-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-665-5040
Provider Business Practice Location Address Fax Number:
410-665-0069
Provider Enumeration Date:
01/11/2007