Provider First Line Business Practice Location Address:
3010 S. SOUTHEAST BLVD.
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99223-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-534-0569
Provider Business Practice Location Address Fax Number:
509-534-5665
Provider Enumeration Date:
07/01/2005