Provider First Line Business Practice Location Address:
615 N SULLIVAN RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-8574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-241-3088
Provider Business Practice Location Address Fax Number:
509-241-3089
Provider Enumeration Date:
08/12/2011