Provider First Line Business Practice Location Address:
9631 N NEVADA ST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-1271
Provider Business Practice Location Address Fax Number:
509-466-0969
Provider Enumeration Date:
08/10/2005