Provider First Line Business Practice Location Address:
2700 MARTIN LUTHER KING JR AVE SE
Provider Second Line Business Practice Location Address:
SAINT ELIZABETHS HOSPITAL DENTAL SMITH BLDG ROOM 103
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20032-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-645-7466
Provider Business Practice Location Address Fax Number:
202-645-7569
Provider Enumeration Date:
08/08/2007