Provider First Line Business Practice Location Address:
22 W CENTRAL AVE
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:
99205-6221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-484-7578
Provider Business Practice Location Address Fax Number:
509-484-9441
Provider Enumeration Date:
03/19/2014