Provider First Line Business Practice Location Address:
12833 ASHWORTH AVE N
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:
98133-7622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-353-7855
Provider Business Practice Location Address Fax Number:
206-306-0506
Provider Enumeration Date:
04/16/2007