Provider First Line Business Practice Location Address:
1660 S COLUMBIAN WAY
Provider Second Line Business Practice Location Address:
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:
98108-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-2965
Provider Business Practice Location Address Fax Number:
206-764-2936
Provider Enumeration Date:
09/14/2006