Provider First Line Business Practice Location Address:
1201 11TH STREET
Provider Second Line Business Practice Location Address:
SUITE 204B
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-7064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-441-1718
Provider Business Practice Location Address Fax Number:
360-734-6727
Provider Enumeration Date:
07/18/2007