Provider First Line Business Practice Location Address:
1016 16TH ST NW BSMT LL
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:
20036-5729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-215-7100
Provider Business Practice Location Address Fax Number:
202-452-1415
Provider Enumeration Date:
11/25/2015