Provider First Line Business Practice Location Address:
650 WEST BALTIMORE STREET 5 SOUTH ROOM 5215
Provider Second Line Business Practice Location Address:
UNIVERSITY OF MARYLAND DENTAL SCHOOL
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-1586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-706-8125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2008