Provider First Line Business Practice Location Address:
119 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-671-7067
Provider Business Practice Location Address Fax Number:
360-933-4045
Provider Enumeration Date:
03/19/2007