Provider First Line Business Practice Location Address: 
1231 GOOD HOPE RD SE STE 106B
    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: 
20020-6907
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-271-8559
    Provider Business Practice Location Address Fax Number: 
202-486-7504
    Provider Enumeration Date: 
11/28/2012