Provider First Line Business Practice Location Address: 
3030 S FINDLAY ST
    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: 
98108-3058
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-504-3143
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/25/2012