Provider First Line Business Practice Location Address:
1314 E SUSAN LN
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:
99223-6205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-953-0145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2006