Provider First Line Business Practice Location Address:
4000 W NORTHERN PKWY STE 2
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:
21215-4473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-367-1299
Provider Business Practice Location Address Fax Number:
410-367-7878
Provider Enumeration Date:
07/14/2006