Provider First Line Business Practice Location Address:
1700 REISTERSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-486-0927
Provider Business Practice Location Address Fax Number:
410-358-4020
Provider Enumeration Date:
03/23/2006