Provider First Line Business Practice Location Address:
650 W BALTIMORE STREET
Provider Second Line Business Practice Location Address:
4TH FLOOR - PERIODONTICS DEPT
Provider Business Practice Location Address City Name:
BALTIMORE
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:
410-706-7162
Provider Business Practice Location Address Fax Number:
410-706-7201
Provider Enumeration Date:
08/26/2011