Provider First Line Business Practice Location Address:
3104 S REGAL 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:
99223-4733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-2277
Provider Business Practice Location Address Fax Number:
509-535-5966
Provider Enumeration Date:
02/01/2007