Provider First Line Business Practice Location Address:
12459 AMBAUM BLVD SW
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98146-2696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-444-6533
Provider Business Practice Location Address Fax Number:
206-439-0426
Provider Enumeration Date:
04/19/2007