Provider First Line Business Practice Location Address:
5814 S THISTLE LN
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:
99223-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-651-0179
Provider Business Practice Location Address Fax Number:
208-651-0179
Provider Enumeration Date:
12/19/2006