Provider First Line Business Practice Location Address:
120 W BUCKEYE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-1977
Provider Business Practice Location Address Fax Number:
509-323-1607
Provider Enumeration Date:
03/24/2011