Provider First Line Business Practice Location Address:
1328 SOUTHERN AVE SE
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:
20032-4689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-561-8464
Provider Business Practice Location Address Fax Number:
202-563-3861
Provider Enumeration Date:
06/30/2005