Provider First Line Business Practice Location Address:
101 E HAWTHORNE RD
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:
99218-1463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-0411
Provider Business Practice Location Address Fax Number:
509-468-0532
Provider Enumeration Date:
08/18/2006