Provider First Line Business Practice Location Address: 
3300 GALLOWS RD
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF MEDICINE
    Provider Business Practice Location Address City Name: 
FALLS CHURCH
    Provider Business Practice Location Address State Name: 
VA
    Provider Business Practice Location Address Postal Code: 
22042
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
703-776-3582
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/28/2008