Provider First Line Business Practice Location Address:
815 MERCER ST. BOX 358047
Provider Second Line Business Practice Location Address:
UW MEDICINE-SOUTH LAKE UNION
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-543-3654
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2017