Provider First Line Business Practice Location Address:
2703 MARTIN LUTHER KING, JR., AVE SE
Provider Second Line Business Practice Location Address:
BASE NCR CLINIC
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-372-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2005