Provider First Line Business Practice Location Address:
6306 1/2 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:
21212-2635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-863-5206
Provider Business Practice Location Address Fax Number:
443-863-5207
Provider Enumeration Date:
11/01/2006