Provider First Line Business Practice Location Address:
1912 N DIVISION ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-2230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-326-5620
Provider Business Practice Location Address Fax Number:
509-326-4686
Provider Enumeration Date:
09/07/2016