Provider First Line Business Practice Location Address:
1959 NE PACIFIC STREET, SEATTLE WA 98195-7263
Provider Second Line Business Practice Location Address:
ROOM T-301
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-7263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-612-6111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2025