Provider First Line Business Practice Location Address:
1922 BENNING RD 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:
20002-4788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-399-2244
Provider Business Practice Location Address Fax Number:
202-388-1115
Provider Enumeration Date:
12/18/2012