Provider First Line Business Practice Location Address: 
1100 9TH AVE
    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: 
98101-2756
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-583-2299
    Provider Business Practice Location Address Fax Number: 
206-223-6395
    Provider Enumeration Date: 
08/31/2006