Provider First Line Business Practice Location Address:
5901 N MAYFAIR ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-5096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-8400
Provider Business Practice Location Address Fax Number:
509-928-1845
Provider Enumeration Date:
12/27/2010