Provider First Line Business Practice Location Address: 
5225 WISCONSIN AVE NW
    Provider Second Line Business Practice Location Address: 
SUITE 400 THE ROSS CENTER
    Provider Business Practice Location Address City Name: 
WASHINGTON
    Provider Business Practice Location Address State Name: 
DC
    Provider Business Practice Location Address Postal Code: 
20015
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-363-1010
    Provider Business Practice Location Address Fax Number: 
202-363-2383
    Provider Enumeration Date: 
12/18/2007