Provider First Line Business Practice Location Address:
110 IRVING ST NW
Provider Second Line Business Practice Location Address:
WASHINGTON HOSPITAL CENTER, ROOM 1A50A1-AB6
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-877-8284
Provider Business Practice Location Address Fax Number:
202-877-5262
Provider Enumeration Date:
07/04/2006