Provider First Line Business Practice Location Address:
5901 N MAYFAIR ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-482-0848
Provider Business Practice Location Address Fax Number:
509-482-0760
Provider Enumeration Date:
10/14/2005