Provider First Line Business Practice Location Address:
1316 KING ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98229-6263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-715-3088
Provider Business Practice Location Address Fax Number:
360-715-3024
Provider Enumeration Date:
01/31/2007