Provider First Line Business Practice Location Address:
112 OHIO ST
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-392-2838
Provider Business Practice Location Address Fax Number:
360-599-8999
Provider Enumeration Date:
02/20/2007