Provider First Line Business Practice Location Address:
419 QUEEN ANNE AVE N
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-284-3747
Provider Business Practice Location Address Fax Number:
206-284-7522
Provider Enumeration Date:
01/14/2011