Provider First Line Business Practice Location Address:
5025 E SPRAGUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-0814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-795-3601
Provider Business Practice Location Address Fax Number:
509-534-1012
Provider Enumeration Date:
09/29/2005