Provider First Line Business Practice Location Address:
3800 RESERVOIR RD NW
Provider Second Line Business Practice Location Address:
RM B-105 LOWER LEVEL KOBER-COGAN BLDG, GEORGETOWN UNIV
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20007-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-687-2906
Provider Business Practice Location Address Fax Number:
202-687-8579
Provider Enumeration Date:
07/12/2005