Provider First Line Business Practice Location Address: 
7600 GEORGIA AVE NW
    Provider Second Line Business Practice Location Address: 
SUITE 323
    Provider Business Practice Location Address City Name: 
WASHINGTON
    Provider Business Practice Location Address State Name: 
DC
    Provider Business Practice Location Address Postal Code: 
20012-1616
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
202-723-3060
    Provider Business Practice Location Address Fax Number: 
202-723-3065
    Provider Enumeration Date: 
10/08/2012