Provider First Line Business Practice Location Address:
1218 18TH PL NE APT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20002-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-948-7894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2026