Provider First Line Business Practice Location Address:
THE N.W. PSYCHOANALYTIC BLDG. 4033 E. MADISON ST.
Provider Second Line Business Practice Location Address:
STE. 108
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-861-8295
Provider Business Practice Location Address Fax Number:
206-324-3276
Provider Enumeration Date:
11/23/2007