Provider First Line Business Practice Location Address:
1614 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-991-7203
Provider Business Practice Location Address Fax Number:
509-455-5164
Provider Enumeration Date:
02/13/2007