Provider First Line Business Practice Location Address:
3970 RESERVOIR RD NW
Provider Second Line Business Practice Location Address:
LCCC GEORGETOWN UNIVERSITY MEDICAL CENTER ROOM E501
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20007-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-687-2110
Provider Business Practice Location Address Fax Number:
202-687-6402
Provider Enumeration Date:
07/25/2006