Provider First Line Business Practice Location Address:
12615 E MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-2623
Provider Business Practice Location Address Fax Number:
509-891-2624
Provider Enumeration Date:
08/08/2008