Provider First Line Business Practice Location Address:
5901 N MAYFAIR ST
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-5096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-3791
Provider Business Practice Location Address Fax Number:
509-483-2272
Provider Enumeration Date:
03/21/2007