Provider First Line Business Practice Location Address:
407 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
STE 864
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-5303
Provider Business Practice Location Address Fax Number:
509-624-3044
Provider Enumeration Date:
12/22/2006