Provider First Line Business Practice Location Address:
1210 INGRAHAM ST NW
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:
20011-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-460-6876
Provider Business Practice Location Address Fax Number:
202-559-5344
Provider Enumeration Date:
01/23/2024