Provider First Line Business Practice Location Address:
1660 COLUMBIAN WAY SOUTH (S-111-DERM)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108-1597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-2305
Provider Business Practice Location Address Fax Number:
206-764-2689
Provider Enumeration Date:
09/14/2006