Provider First Line Business Practice Location Address:
2401 E STREET NW
Provider Second Line Business Practice Location Address:
DEPARTMENT OF STATE OFFICE OF MEDICAL SERVICES
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-663-2453
Provider Business Practice Location Address Fax Number:
202-663-3247
Provider Enumeration Date:
04/06/2007