Provider First Line Business Practice Location Address:
601 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-2353
Provider Business Practice Location Address Fax Number:
509-624-2501
Provider Enumeration Date:
10/27/2005