Provider First Line Business Practice Location Address:
15010 ASHWORTH AVENUE 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:
98133-0430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-365-3672
Provider Business Practice Location Address Fax Number:
206-365-3713
Provider Enumeration Date:
06/19/2007