Provider First Line Business Practice Location Address: 
925 SENECA ST
    Provider Second Line Business Practice Location Address: 
MAILSTOP H3-PI
    Provider Business Practice Location Address City Name: 
SEATTLE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98101
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-583-6011
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/19/2011