Provider First Line Business Practice Location Address: 
444 NE RAVENNA BLVD STE 301
    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: 
98115-6467
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
206-218-7432
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/25/2007