Provider First Line Business Practice Location Address:
801 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 622
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-5145
Provider Business Practice Location Address Fax Number:
509-456-0062
Provider Enumeration Date:
10/04/2005