Provider First Line Business Practice Location Address:
1514 12TH STREET
Provider Second Line Business Practice Location Address:
SUITE #103
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:
360-752-2673
Provider Business Practice Location Address Fax Number:
360-752-0271
Provider Enumeration Date:
11/08/2006