Provider First Line Business Practice Location Address:
111 MICHIGAN AVE NW
Provider Second Line Business Practice Location Address:
CHILDREN'S NATIONAL MEDICAL CENTER, ID DIV-SIS CLINIC
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-712-0027
Provider Business Practice Location Address Fax Number:
202-216-3702
Provider Enumeration Date:
11/21/2006