Provider First Line Business Practice Location Address:
222 W MISSION AVE STE 125
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:
99201-2341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-725-7008
Provider Business Practice Location Address Fax Number:
772-607-5274
Provider Enumeration Date:
10/16/2006