Provider First Line Business Practice Location Address:
5608 S REGAL ST STE 102
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:
99223-7957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-0896
Provider Business Practice Location Address Fax Number:
509-838-1085
Provider Enumeration Date:
09/06/2006