Provider First Line Business Practice Location Address:
1344 KING ST
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98229-6215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-524-9388
Provider Business Practice Location Address Fax Number:
360-841-7054
Provider Enumeration Date:
11/16/2006