Provider First Line Business Practice Location Address: 
1959 NE PACIFIC ST
    Provider Second Line Business Practice Location Address: 
UWMC PAIN CLINIC
    Provider Business Practice Location Address City Name: 
SEATTLE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98195-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-543-6420
    Provider Business Practice Location Address Fax Number: 
206-520-5620
    Provider Enumeration Date: 
05/08/2013