Provider First Line Business Practice Location Address:
M/MED/QI SA-01 GOVERNMENT AGENCY
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:
20522-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-736-9044
Provider Business Practice Location Address Fax Number:
202-736-9044
Provider Enumeration Date:
01/30/2007