Provider First Line Business Practice Location Address: 
5840 MACARTHUR BLVD NW
    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: 
20016-2542
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-966-8108
    Provider Business Practice Location Address Fax Number: 
202-966-8106
    Provider Enumeration Date: 
03/26/2007