Provider First Line Business Practice Location Address:
4220 S OTHELLO ST UNIT 570
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:
98118-4096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-678-7336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2025