Provider First Line Business Practice Location Address:
2607 S SOUTHEAST BLVD
Provider Second Line Business Practice Location Address:
SUITE B-111
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99223-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-953-7392
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2009