Provider First Line Business Practice Location Address:
104 S FREYA ST STE 225
Provider Second Line Business Practice Location Address:
TURQUOISE FLAG BLDG
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-4887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-536-1900
Provider Business Practice Location Address Fax Number:
509-343-5199
Provider Enumeration Date:
03/14/2016