Provider First Line Business Practice Location Address:
309 E FARWELL RD STE 104
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:
99218-8206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-2139
Provider Business Practice Location Address Fax Number:
509-465-2548
Provider Enumeration Date:
10/06/2006