Provider First Line Business Practice Location Address:
12121 E BROADWAY
Provider Second Line Business Practice Location Address:
BLDG III
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-3363
Provider Business Practice Location Address Fax Number:
509-924-7680
Provider Enumeration Date:
09/22/2006