Provider First Line Business Practice Location Address: 
530 7TH ST SE
    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: 
20003-2768
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-543-4645
    Provider Business Practice Location Address Fax Number: 
202-543-4645
    Provider Enumeration Date: 
03/01/2006