Provider First Line Business Practice Location Address:
1402 S GRAND BLVD
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:
99203-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-8220
Provider Business Practice Location Address Fax Number:
509-455-9172
Provider Enumeration Date:
09/22/2006