Provider First Line Business Practice Location Address:
8000 YORK RD
Provider Second Line Business Practice Location Address:
FIELD HOUSE 101
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21252-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-512-5820
Provider Business Practice Location Address Fax Number:
410-512-5859
Provider Enumeration Date:
08/04/2021