Provider First Line Business Practice Location Address:
1817 QUEEN ANNE AVE N
Provider Second Line Business Practice Location Address:
207
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:
206-788-5300
Provider Business Practice Location Address Fax Number:
888-456-8897
Provider Enumeration Date:
10/25/2006