Provider First Line Business Practice Location Address:
2401 HAWKINS POINT RD
Provider Second Line Business Practice Location Address:
COAST GUARD YARD CLINIC
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21226-1797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-636-3181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2005