Provider First Line Business Practice Location Address:
1160 VARNUM ST NE
Provider Second Line Business Practice Location Address:
PROVIDENCE HOSPITAL SUITE 006
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-269-7103
Provider Business Practice Location Address Fax Number:
202-635-7145
Provider Enumeration Date:
11/02/2006