Provider First Line Business Practice Location Address:
4220 S OTHELLO ST UNIT 639
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:
98118-4095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-227-2033
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2026