Provider First Line Business Practice Location Address:
42 E ROWAN AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-483-3155
Provider Business Practice Location Address Fax Number:
509-483-3270
Provider Enumeration Date:
12/07/2007