Provider First Line Business Practice Location Address:
2401 W BELVEDERE AVE
Provider Second Line Business Practice Location Address:
CDCR
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:
410-601-8450
Provider Business Practice Location Address Fax Number:
410-601-1470
Provider Enumeration Date:
03/05/2009