Provider First Line Business Practice Location Address:
9505 HARFORD 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:
21234-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-663-2012
Provider Business Practice Location Address Fax Number:
410-663-2015
Provider Enumeration Date:
10/07/2005