Provider First Line Business Practice Location Address:
1424 S BERNARD ST STE C
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:
99203-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-7022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2011