Provider First Line Business Practice Location Address:
1660 COLUMBIAN WAY (116-MHC)
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-2458
Provider Business Practice Location Address Fax Number:
206-764-2572
Provider Enumeration Date:
09/06/2006