Provider First Line Business Practice Location Address:
8120 E. VISTA LANE
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:
99212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-216-6881
Provider Business Practice Location Address Fax Number:
509-924-0242
Provider Enumeration Date:
03/08/2007