Provider First Line Business Practice Location Address:
5619 SOUTH CUSTER RD.
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:
99223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-499-3366
Provider Business Practice Location Address Fax Number:
509-290-5555
Provider Enumeration Date:
09/14/2015