Provider First Line Business Practice Location Address:
1625 W 4TH 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:
99204-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-5665
Provider Business Practice Location Address Fax Number:
509-456-7703
Provider Enumeration Date:
03/01/2007