Provider First Line Business Practice Location Address:
14213 AMBAUM BLVD SW
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:
98166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-243-9222
Provider Business Practice Location Address Fax Number:
206-243-3343
Provider Enumeration Date:
11/30/2006