Provider First Line Business Practice Location Address:
407 E 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 254
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-953-5850
Provider Business Practice Location Address Fax Number:
509-747-5990
Provider Enumeration Date:
05/16/2007