Provider First Line Business Practice Location Address:
628 S MAPLE ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-353-9885
Provider Business Practice Location Address Fax Number:
509-353-9886
Provider Enumeration Date:
01/21/2013