Provider First Line Business Practice Location Address: 
2901 SQUALICUM PKWY
    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: 
98225-1851
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
360-788-6300
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/05/2022