Provider First Line Business Practice Location Address:
2139 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
FACULTY PRAC PLAN
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-865-7499
Provider Business Practice Location Address Fax Number:
202-865-3875
Provider Enumeration Date:
06/19/2008