Provider First Line Business Practice Location Address:
ROOM 97 EEOB
Provider Second Line Business Practice Location Address:
WHITE HOUSE MEDICAL UNIT
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-757-2476
Provider Business Practice Location Address Fax Number:
202-757-2472
Provider Enumeration Date:
07/24/2012