Provider First Line Business Practice Location Address:
STATE OFFICE MED SERVICES 2401 E ST NW
Provider Second Line Business Practice Location Address:
SA 1, ROOM L209
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20522-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-663-1681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2007