Provider First Line Business Practice Location Address:
MARINE BARRACKS WASHINGTON
Provider Second Line Business Practice Location Address:
8TH & I STS SE
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20390-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-433-5865
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2006