
First Name
Amber Waelchi
Last Name
Doe
Date of Birth
2001-06-09
Gender
Other
Phone Number
(553) 841-6125
Insurance Provider
Kohler, Lakin and Labadie
Patient ID
13690
Emergency Contact
Jane Doe (+1 987 654 3210)
Street Address
123 Main St, Apt 4B
City
Denver
State/Province
Colorado
Zip Code
80202
Country
United States
Emergency Contact Address
456 Elm St, Apt 10C, Denver, CO