Provider First Line Business Practice Location Address:
5011 W LOWELL AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-8587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-777-0610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2006