Provider First Line Business Practice Location Address:
316 W. BOONE
Provider Second Line Business Practice Location Address:
SUITE 669
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-6970
Provider Business Practice Location Address Fax Number:
509-326-8743
Provider Enumeration Date:
06/03/2010