Provider First Line Business Practice Location Address:
4940 EASTERN AVENUE
Provider Second Line Business Practice Location Address:
A 5 EAST 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-550-9415
Provider Business Practice Location Address Fax Number:
410-550-7861
Provider Enumeration Date:
11/01/2006