Provider First Line Business Practice Location Address:
120 PROSPECT ST STE 1
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:
98225-4428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-303-8961
Provider Business Practice Location Address Fax Number:
360-734-4148
Provider Enumeration Date:
03/01/2007