Provider First Line Business Practice Location Address:
1528 W AUGUSTA AVE
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:
99205-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-9888
Provider Business Practice Location Address Fax Number:
509-448-2057
Provider Enumeration Date:
03/13/2007