Provider First Line Business Practice Location Address:
1344 KING ST
Provider Second Line Business Practice Location Address:
SUITE 101
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:
360-676-6393
Provider Business Practice Location Address Fax Number:
360-676-6394
Provider Enumeration Date:
01/27/2011