Provider First Line Business Practice Location Address:
106 IRVING ST NW
Provider Second Line Business Practice Location Address:
POB #3800 NORTH WASHINGTON HOSPITAL CENTER
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-877-6093
Provider Business Practice Location Address Fax Number:
202-877-8695
Provider Enumeration Date:
07/12/2006