Provider First Line Business Practice Location Address:
1103 W WELLESLEY 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:
99205-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-0447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2007