Provider First Line Business Practice Location Address: 
600 BROADWAY
    Provider Second Line Business Practice Location Address: 
SUITE 190
    Provider Business Practice Location Address City Name: 
SEATTLE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98122-5395
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-323-4040
    Provider Business Practice Location Address Fax Number: 
206-324-0943
    Provider Enumeration Date: 
10/04/2006