Provider First Line Business Practice Location Address:
220 E ROWAN AVE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-2851
Provider Business Practice Location Address Fax Number:
509-484-0103
Provider Enumeration Date:
01/23/2007