Provider First Line Business Practice Location Address:
6508 OLD HARFORD RD STE A
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:
21214-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-486-5016
Provider Business Practice Location Address Fax Number:
410-486-0517
Provider Enumeration Date:
02/05/2007