Provider First Line Business Practice Location Address:
520 BIRCHWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-671-6303
Provider Business Practice Location Address Fax Number:
360-671-0091
Provider Enumeration Date:
07/20/2005