Provider First Line Business Practice Location Address:
1400 KING ST
Provider Second Line Business Practice Location Address:
SUITE B104
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98229-6262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-201-1689
Provider Business Practice Location Address Fax Number:
360-312-4362
Provider Enumeration Date:
09/22/2006