Individual
LESLIE WIERSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12033 SE 256TH STREET, KENT, WA 98030
(253) 373-7000
Mailing address
222 QUEEN ANNE AVE, SEATTLE, WA 98109
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT60174905
WA
Other
Enumeration date
10/18/2012
Last updated
10/18/2012
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