Provider First Line Business Practice Location Address:
1959 NE PACIFIC ST
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT, RR210
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
555-555-5555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2020