Provider First Line Business Practice Location Address:
4815 N ASSEMBLY ST
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:
99205-6185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-434-7274
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006