Provider First Line Business Practice Location Address:
1417 QUEEN ANNE AVE N
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-5748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-284-8852
Provider Business Practice Location Address Fax Number:
206-284-8736
Provider Enumeration Date:
07/26/2006