Provider First Line Business Practice Location Address:
2480 LLEWELLYN AVE.
Provider Second Line Business Practice Location Address:
ATTN: MCXR-CR KIMBROUGH AMBULATORY CARE CENTER
Provider Business Practice Location Address City Name:
FT. MEADE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-677-8270
Provider Business Practice Location Address Fax Number:
301-677-8176
Provider Enumeration Date:
11/30/2005