Provider First Line Business Practice Location Address: 
1401 MADISON ST
    Provider Second Line Business Practice Location Address: 
STE 100
    Provider Business Practice Location Address City Name: 
SEATTLE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98104-1316
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-386-6111
    Provider Business Practice Location Address Fax Number: 
206-320-6113
    Provider Enumeration Date: 
05/20/2006