Provider First Line Business Practice Location Address:
1660 S COLUMBIAN WAY,
Provider Second Line Business Practice Location Address:
PSHCS, MAIL STOP: S - 116 - DDTP
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-2163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006