Provider First Line Business Practice Location Address:
28 E INDIANA 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:
99207-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-323-1494
Provider Business Practice Location Address Fax Number:
509-323-1503
Provider Enumeration Date:
02/02/2006