Provider First Line Business Practice Location Address:
KIMBROUGH AMBULATORY CARE CENTER
Provider Second Line Business Practice Location Address:
ATTN: OPTOMETRY
Provider Business Practice Location Address City Name:
FORT MEADE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21044-5800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-677-8378
Provider Business Practice Location Address Fax Number:
301-677-8077
Provider Enumeration Date:
11/14/2005