Provider First Line Business Practice Location Address:
4235 S CHENEY SPOKANE RD
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:
99224-9661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-462-5691
Provider Business Practice Location Address Fax Number:
509-462-5694
Provider Enumeration Date:
11/16/2015