Provider First Line Business Practice Location Address:
3136 SQUALICUM PKWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-543-6808
Provider Business Practice Location Address Fax Number:
360-809-6008
Provider Enumeration Date:
12/08/2025