Individual
KOKU ADELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20440 MEADOW POND PL, GAITHERSBURG, MD 20886-1130
(301) 938-3208
Mailing address
20440 MEADOW POND PLACE, GAITHERSBURG, MD 20886
(301) 938-3208
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
8116
MD
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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