Provider First Line Business Practice Location Address:
2242 49TH ST NW
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:
20007-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-997-1312
Provider Business Practice Location Address Fax Number:
202-250-6667
Provider Enumeration Date:
02/11/2009