Provider First Line Business Practice Location Address:
6317 YORK 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:
21212-2359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-777-6890
Provider Business Practice Location Address Fax Number:
410-433-2015
Provider Enumeration Date:
07/17/2010