Provider First Line Business Practice Location Address:
1112 11TH STREET
Provider Second Line Business Practice Location Address:
301
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:
360-414-2222
Provider Business Practice Location Address Fax Number:
360-414-2220
Provider Enumeration Date:
09/25/2005