Provider First Line Business Practice Location Address:
111 MICHIGAN AVE NW
Provider Second Line Business Practice Location Address:
SUITE 4207 ADOLESCENT OFFICE MAIN BLDG.
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-476-4222
Provider Business Practice Location Address Fax Number:
202-476-4760
Provider Enumeration Date:
02/14/2008