Provider First Line Business Practice Location Address:
9211 E MISSION AVE STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-323-9229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006