Provider First Line Business Practice Location Address:
2820 N ASTOR 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:
99207-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-252-5792
Provider Business Practice Location Address Fax Number:
509-340-7323
Provider Enumeration Date:
10/19/2016