Provider First Line Business Practice Location Address:
5510 N DRISCOLL BLVD
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:
99205-7624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-8817
Provider Business Practice Location Address Fax Number:
509-328-4046
Provider Enumeration Date:
10/19/2006