Provider First Line Business Practice Location Address: 
UW DEPARTMENT OF ORAL SURGERY - BX 357134
    Provider Second Line Business Practice Location Address: 
1959 NE PACIFIC ST.
    Provider Business Practice Location Address City Name: 
SEATTLE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98195
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
615-686-5117
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/27/2023