Provider First Line Business Practice Location Address:
10 N GREENE STREET BT/127
Provider Second Line Business Practice Location Address:
VA MARYLAND HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-605-7060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006