Provider First Line Business Practice Location Address: 
2401 W BELVEDERE AVE
    Provider Second Line Business Practice Location Address: 
DEPT OF REHAB MEDICINE
    Provider Business Practice Location Address City Name: 
BALTIMORE
    Provider Business Practice Location Address State Name: 
MD
    Provider Business Practice Location Address Postal Code: 
21215-5216
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
410-601-5906
    Provider Business Practice Location Address Fax Number: 
410-601-6071
    Provider Enumeration Date: 
05/10/2006