Provider First Line Business Practice Location Address:
2401 W BELVEDERE AVE
Provider Second Line Business Practice Location Address:
NEUROSCIENCE HOUSE OFFICER OFFICE
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:
410-601-1544
Provider Business Practice Location Address Fax Number:
410-601-1543
Provider Enumeration Date:
08/22/2007