Provider First Line Business Practice Location Address:
2610 E 29TH AVE
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:
99223-4806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-3683
Provider Business Practice Location Address Fax Number:
509-535-8413
Provider Enumeration Date:
10/10/2005