Provider First Line Business Practice Location Address: 
4120 MERIDIAN ST STE 250
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BELLINGHAM
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98226-5575
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
360-922-3030
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/25/2022