Provider First Line Business Practice Location Address:
1325 W 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-4135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-863-5851
Provider Business Practice Location Address Fax Number:
509-838-1390
Provider Enumeration Date:
02/22/2007