Provider First Line Business Practice Location Address:
3010 SQUALICUM PKWY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-733-7046
Provider Business Practice Location Address Fax Number:
360-647-5437
Provider Enumeration Date:
11/28/2006