Provider First Line Business Practice Location Address:
USCG HEADQUARTERS CLINIC
Provider Second Line Business Practice Location Address:
2100 SECOND ST. SW ,ROOM B732
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20593-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-372-4100
Provider Business Practice Location Address Fax Number:
202-372-4910
Provider Enumeration Date:
10/10/2006