Provider First Line Business Practice Location Address:
800 E CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 3C
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-5241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-734-0298
Provider Business Practice Location Address Fax Number:
360-734-9679
Provider Enumeration Date:
04/30/2010