Provider First Line Business Practice Location Address:
5615 W SUNSET HWY
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:
99224-9454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-241-7572
Provider Business Practice Location Address Fax Number:
509-434-3118
Provider Enumeration Date:
02/01/2007