Provider First Line Business Practice Location Address:
2120 BLADENSBURG RD NE
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:
20018-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-540-9857
Provider Business Practice Location Address Fax Number:
202-232-8494
Provider Enumeration Date:
10/27/2011