Provider First Line Business Practice Location Address:
850 REPUBLICAN STREET, BROTMAN ROOM 242
Provider Second Line Business Practice Location Address:
UW MEDICAL CENTER AT 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-713-7216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2013