Provider First Line Business Practice Location Address: 
545 RAINIER BLVD N
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ISSAQUAH
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98027-2806
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-856-7300
    Provider Business Practice Location Address Fax Number: 
425-837-0693
    Provider Enumeration Date: 
12/18/2007