Provider First Line Business Practice Location Address: 
1130 N 185TH ST
    Provider Second Line Business Practice Location Address: 
STE 201
    Provider Business Practice Location Address City Name: 
SHORELINE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98133-4011
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-542-1000
    Provider Business Practice Location Address Fax Number: 
206-542-5353
    Provider Enumeration Date: 
06/23/2011