Provider First Line Business Practice Location Address:
200 N MULLAN RD
Provider Second Line Business Practice Location Address:
STE 222
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-3793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-590-3799
Provider Business Practice Location Address Fax Number:
509-277-0136
Provider Enumeration Date:
03/22/2007