Provider First Line Business Practice Location Address: 
475 INGRAHAM ST NE
    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: 
20011-2602
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-526-2200
    Provider Business Practice Location Address Fax Number: 
202-526-2202
    Provider Enumeration Date: 
04/11/2018