Provider First Line Business Practice Location Address:
8113 HARFORD RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234-5790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-882-5882
Provider Business Practice Location Address Fax Number:
410-882-2933
Provider Enumeration Date:
10/14/2008