Provider First Line Business Practice Location Address:
6900 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
WRAMC - WD 77
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20307-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-782-5729
Provider Business Practice Location Address Fax Number:
202-782-9032
Provider Enumeration Date:
10/11/2006