Provider First Line Business Practice Location Address:
2027 W INDIANA 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:
99205-4142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-5973
Provider Business Practice Location Address Fax Number:
509-315-4077
Provider Enumeration Date:
11/30/2006