Provider First Line Business Practice Location Address:
1617 W NORTHWEST BLVD
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:
99205-4276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-326-7022
Provider Business Practice Location Address Fax Number:
509-323-1933
Provider Enumeration Date:
10/24/2007