Provider First Line Business Practice Location Address: 
3222 CALIFORNIA AVE SW
    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: 
98116-3305
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-934-0477
    Provider Business Practice Location Address Fax Number: 
206-939-5556
    Provider Enumeration Date: 
04/11/2007