Provider First Line Business Practice Location Address:
55 WADE AVENUE
Provider Second Line Business Practice Location Address:
MARYLAND PSYCHIATRIC RESEARCH CENTER
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-402-6818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2005