Provider First Line Business Practice Location Address:
3815 S OTHELLO ST STE 100229
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:
98118-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-721-2838
Provider Business Practice Location Address Fax Number:
206-212-0008
Provider Enumeration Date:
06/30/2005