Provider First Line Business Practice Location Address:
104 WEST 5TH
Provider Second Line Business Practice Location Address:
SUITE 250E
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-8610
Provider Business Practice Location Address Fax Number:
509-835-4058
Provider Enumeration Date:
08/29/2006