Provider First Line Business Practice Location Address:
104 W 5TH AVE STE 250E
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:
99204-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-473-7672
Provider Business Practice Location Address Fax Number:
509-473-7680
Provider Enumeration Date:
12/28/2007