Provider First Line Business Practice Location Address:
1106 HARRIS AVE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-319-7938
Provider Business Practice Location Address Fax Number:
360-756-2706
Provider Enumeration Date:
09/02/2006