Provider First Line Business Practice Location Address:
605 E HOLLAND AVE
Provider Second Line Business Practice Location Address:
STE 214
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
506-467-6128
Provider Business Practice Location Address Fax Number:
509-467-6155
Provider Enumeration Date:
06/17/2005