Provider First Line Business Practice Location Address:
1400 INDEPENDENCE AVE SW
Provider Second Line Business Practice Location Address:
MEDICAL SERVICES - ROOM: 1409-SBLDG
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20250-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-720-3893
Provider Business Practice Location Address Fax Number:
202-720-6567
Provider Enumeration Date:
12/01/2011