Provider First Line Business Practice Location Address:
3919 N. MAPLE 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:
99205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-444-7801
Provider Business Practice Location Address Fax Number:
509-343-1119
Provider Enumeration Date:
10/11/2011