Provider First Line Business Practice Location Address:
5633 N LIDGERWOOD ST
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:
99208-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-482-0111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2007