Provider First Line Business Practice Location Address: 
3800 RESERVOIR ROAD NW
    Provider Second Line Business Practice Location Address: 
PHYSICAL MEDICINE AND REHABILITATION
    Provider Business Practice Location Address City Name: 
WASHINGTON
    Provider Business Practice Location Address State Name: 
DC
    Provider Business Practice Location Address Postal Code: 
20007-2187
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-444-3692
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/26/2007