Provider First Line Business Practice Location Address:
3130 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:
98225-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-339-5412
Provider Business Practice Location Address Fax Number:
360-363-4750
Provider Enumeration Date:
04/10/2006