Provider First Line Business Practice Location Address: 
ENDOCRINE AND DIABETES CENTER
    Provider Second Line Business Practice Location Address: 
2200 OPITZ BLVD, SUITE 250
    Provider Business Practice Location Address City Name: 
WOODBRIDGE
    Provider Business Practice Location Address State Name: 
VA
    Provider Business Practice Location Address Postal Code: 
20112
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
703-494-5858
    Provider Business Practice Location Address Fax Number: 
703-491-1416
    Provider Enumeration Date: 
10/17/2006