Provider First Line Business Practice Location Address:
6104 OLD BRANCH AVENUE
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE, PPQA, 6 WEST, ATTN THERESA BROOKS
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-702-6100
Provider Business Practice Location Address Fax Number:
301-702-6367
Provider Enumeration Date:
12/28/2006