Provider First Line Business Practice Location Address: 
201 16TH AVE E
    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: 
98112-5226
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-326-3000
    Provider Business Practice Location Address Fax Number: 
206-326-2785
    Provider Enumeration Date: 
08/26/2014