Provider First Line Business Practice Location Address:
2831 15TH ST. NW
Provider Second Line Business Practice Location Address:
LA CLINICA DEL PUEBLO
Provider Business Practice Location Address City Name:
WASHINTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-462-4788
Provider Business Practice Location Address Fax Number:
202-667-3706
Provider Enumeration Date:
11/28/2005