Provider First Line Business Practice Location Address: 
1229 MADISON ST
    Provider Second Line Business Practice Location Address: 
SEARAD SUITE 900
    Provider Business Practice Location Address City Name: 
SEATTLE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98104-3586
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-995-1135
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/24/2006