Provider First Line Business Practice Location Address:
10 N GREENE ST
Provider Second Line Business Practice Location Address:
VETERANS AFFAIRS MEDICAL CENTER
Provider Business Practice Location Address City Name:
BALT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-605-7428
Provider Business Practice Location Address Fax Number:
410-605-7724
Provider Enumeration Date:
04/19/2006