Provider First Line Business Practice Location Address:
5627 N HEMLOCK ST
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:
99205-7049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-981-6288
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2011