Provider First Line Business Practice Location Address: 
747 ALABAMA AVE SE
    Provider Second Line Business Practice Location Address: 
SUITE 2
    Provider Business Practice Location Address City Name: 
WASHINGTON
    Provider Business Practice Location Address State Name: 
DC
    Provider Business Practice Location Address Postal Code: 
20032-4150
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-563-0100
    Provider Business Practice Location Address Fax Number: 
202-563-7780
    Provider Enumeration Date: 
08/31/2006