Provider First Line Business Practice Location Address: 
110 IRVING STREET NW
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
    Provider Business Practice Location Address City Name: 
WASHINGTON
    Provider Business Practice Location Address State Name: 
DC
    Provider Business Practice Location Address Postal Code: 
20010
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-877-8035
    Provider Business Practice Location Address Fax Number: 
202-877-7029
    Provider Enumeration Date: 
03/26/2022