Provider First Line Business Practice Location Address:
1660 S COLUMBIAN WAY
Provider Second Line Business Practice Location Address:
VA PUGET SOUND HCS (S-123-PCC)
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:
206-277-5088
Provider Business Practice Location Address Fax Number:
206-764-2936
Provider Enumeration Date:
11/17/2008