Provider First Line Business Practice Location Address:
485 W HORTON RD STE 101
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:
98226-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-483-0180
Provider Business Practice Location Address Fax Number:
360-306-3742
Provider Enumeration Date:
11/21/2006