Provider First Line Business Practice Location Address:
1215 OLD FAIRHAVEN PKWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-7444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-594-4002
Provider Business Practice Location Address Fax Number:
360-594-4006
Provider Enumeration Date:
06/20/2008