Provider First Line Business Practice Location Address:
12209 E MISSION AVE STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-443-3145
Provider Business Practice Location Address Fax Number:
509-443-3968
Provider Enumeration Date:
08/18/2005