Provider First Line Business Practice Location Address:
823 W 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-326-6474
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2009