Provider First Line Business Practice Location Address:
6900 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
WALTER REED ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20307-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-782-0388
Provider Business Practice Location Address Fax Number:
202-782-9289
Provider Enumeration Date:
02/09/2006