Provider First Line Business Practice Location Address:
1206 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LUTHERVILLE TIMONIUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-764-7764
Provider Business Practice Location Address Fax Number:
443-835-1118
Provider Enumeration Date:
11/13/2006