Provider First Line Business Practice Location Address:
1215 N MCDONALD RD
Provider Second Line Business Practice Location Address:
SUITE L-2
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-893-4462
Provider Business Practice Location Address Fax Number:
509-893-4482
Provider Enumeration Date:
09/15/2006