Provider First Line Business Practice Location Address:
1117 ELLIS ST
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:
98225-5203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-714-8109
Provider Business Practice Location Address Fax Number:
360-756-8936
Provider Enumeration Date:
02/02/2007