Provider First Line Business Practice Location Address:
408 N MULLAN RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-3863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-5911
Provider Business Practice Location Address Fax Number:
509-928-3911
Provider Enumeration Date:
08/09/2006