Provider First Line Business Practice Location Address:
3628 MERIDIAN ST.
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-671-3977
Provider Business Practice Location Address Fax Number:
360-671-3981
Provider Enumeration Date:
02/19/2007