Provider First Line Business Practice Location Address:
200 NORTH GLEBE RD SUITE 104
Provider Second Line Business Practice Location Address:
PHOENIX HOUSE MID ATLANTIC
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-841-0703
Provider Business Practice Location Address Fax Number:
703-243-0975
Provider Enumeration Date:
03/21/2007