Provider First Line Business Practice Location Address:
10 N GREENE ST., SUITE 4A-150
Provider Second Line Business Practice Location Address:
BT - 127, DEPT. OF NEUROLOGY
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-605-7448
Provider Business Practice Location Address Fax Number:
410-605-7937
Provider Enumeration Date:
05/02/2006