Provider First Line Business Practice Location Address:
1221 MERCANTILE LANE
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE LARGO MEDICAL CENTER
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-992-1060
Provider Business Practice Location Address Fax Number:
301-618-5571
Provider Enumeration Date:
05/10/2008