Provider First Line Business Practice Location Address:
4114 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:
98103-8148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-633-0436
Provider Business Practice Location Address Fax Number:
206-634-4259
Provider Enumeration Date:
05/14/2013