Provider First Line Business Practice Location Address:
104 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 205E
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-4880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-939-9722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006