Provider First Line Business Practice Location Address:
5602 BALTIMORE NATIONAL PIKE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-788-4400
Provider Business Practice Location Address Fax Number:
410-788-4438
Provider Enumeration Date:
05/19/2006