Provider First Line Business Practice Location Address: 
1959 NE PACIFIC ST MAIN HOSPITAL
    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: 
98195-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
248-303-2199
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/10/2025