Provider First Line Business Practice Location Address:
1242 12TH ST NE WASHINGTON D.C.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-269-6600
Provider Business Practice Location Address Fax Number:
240-467-5795
Provider Enumeration Date:
04/15/2020