Provider First Line Business Practice Location Address:
5510 NATHAN SHOCK DR
Provider Second Line Business Practice Location Address:
JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-6823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-550-1917
Provider Business Practice Location Address Fax Number:
410-550-1924
Provider Enumeration Date:
01/19/2007