Provider First Line Business Practice Location Address:
1626 E HARTSON 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:
99202-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-240-0229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2009