Provider First Line Business Practice Location Address:
1660 SOUTH COLUMBIAN WAY
Provider Second Line Business Practice Location Address:
BOX 358280
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98108-8280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-764-2324
Provider Business Practice Location Address Fax Number:
206-768-5382
Provider Enumeration Date:
09/27/2006