Provider First Line Business Practice Location Address: 
922 S COWLEY ST STE 8
    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: 
99202-1263
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-216-7311
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
06/01/2016