Provider First Line Business Practice Location Address:
YORKRIDGE SC
Provider Second Line Business Practice Location Address:
20 WEST RIDGELY ROAD
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-252-0195
Provider Business Practice Location Address Fax Number:
410-683-1779
Provider Enumeration Date:
08/30/2006