Individual
MR. KENNETH A ST. OURS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
8118 GOOD LUCK RD, LANHAM, MD 20706-3595
(301) 498-5990
Mailing address
302 COLONIAL CT, TOWSON, MD 21204-4317
(410) 832-5469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0001047
MD
Other
Enumeration date
10/24/2006
Last updated
10/22/2007
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