Provider First Line Business Practice Location Address:
123 W CASCADE WAY
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-467-1234
Provider Business Practice Location Address Fax Number:
509-467-1235
Provider Enumeration Date:
04/11/2007