Provider First Line Business Practice Location Address:
6315 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:
21212-2359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-321-5497
Provider Business Practice Location Address Fax Number:
410-377-3081
Provider Enumeration Date:
09/20/2007