Provider First Line Business Practice Location Address:
14212 AMBAUM BLVD SW
Provider Second Line Business Practice Location Address:
SOUTHWEST PEDIATRICS #202
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-243-4811
Provider Business Practice Location Address Fax Number:
206-243-2822
Provider Enumeration Date:
05/24/2007