Provider First Line Business Practice Location Address:
1660 S COLUMBIAN WAY, ROOM 6A-102
Provider Second Line Business Practice Location Address:
VETERANS HEALTH ADMINISTRATION PUGET SOUND
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:
415-290-2719
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2010