Provider First Line Business Practice Location Address: 
13023 GREENWOOD AVE. N
    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: 
98133
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-364-1300
    Provider Business Practice Location Address Fax Number: 
971-206-5203
    Provider Enumeration Date: 
11/09/2011