Provider First Line Business Practice Location Address:
8712 ONE HALF E MARINGO DR
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:
99212-1822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-8760
Provider Business Practice Location Address Fax Number:
509-325-3919
Provider Enumeration Date:
09/18/2007