Provider First Line Business Practice Location Address:
650 WEST BALTIMORE STREET,
Provider Second Line Business Practice Location Address:
ROOM, 4209, DEPARTMENT OF PERIODONTICS
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-706-7153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007