Provider First Line Business Practice Location Address:
1004 N. PINES ROAD
Provider Second Line Business Practice Location Address:
SUITE 117
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-1228
Provider Business Practice Location Address Fax Number:
509-838-0277
Provider Enumeration Date:
08/30/2005