Provider First Line Business Practice Location Address:
2801 MERIDIAN ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-738-9588
Provider Business Practice Location Address Fax Number:
360-715-1970
Provider Enumeration Date:
10/12/2006