Provider First Line Business Practice Location Address: 
2401 W BELVEDERE AVE
    Provider Second Line Business Practice Location Address: 
SINAI HOSPITAL GENERAL OPERATING ROOM
    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: 
410-601-5243
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/22/2014