Provider First Line Business Practice Location Address:
4125 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:
98103-8147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-618-8574
Provider Business Practice Location Address Fax Number:
206-397-4473
Provider Enumeration Date:
09/10/2009