Provider First Line Business Practice Location Address:
210 E WELLESLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-1526
Provider Business Practice Location Address Fax Number:
509-624-6219
Provider Enumeration Date:
12/08/2008