Provider First Line Business Practice Location Address:
12109 E BROADWAY AVE
Provider Second Line Business Practice Location Address:
BLDG C
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-6133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-893-3635
Provider Business Practice Location Address Fax Number:
509-926-2833
Provider Enumeration Date:
02/16/2015