Provider First Line Business Practice Location Address:
4200 MERIDIAN ST
Provider Second Line Business Practice Location Address:
STE 212
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-6462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-676-4803
Provider Business Practice Location Address Fax Number:
360-966-9996
Provider Enumeration Date:
10/03/2005