Provider First Line Business Practice Location Address:
1123 N EVERGREEN RD
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:
99216-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-363-3100
Provider Business Practice Location Address Fax Number:
509-363-0300
Provider Enumeration Date:
11/09/2006