Provider First Line Business Practice Location Address:
3103 S SOMMER LN
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:
99037-8311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-994-1330
Provider Business Practice Location Address Fax Number:
509-892-6796
Provider Enumeration Date:
11/20/2006