Provider First Line Business Practice Location Address:
2909 W NORTHWEST BLVD
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:
99205-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-4049
Provider Business Practice Location Address Fax Number:
509-327-0772
Provider Enumeration Date:
10/31/2006