Provider First Line Business Practice Location Address:
1212 N WASHINGTON ST STE 104
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:
99201-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-638-2958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2009