Provider First Line Business Practice Location Address:
104 S. FREYA STREET, BLUE FLAG BLDG.
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-4862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-3668
Provider Business Practice Location Address Fax Number:
509-928-6661
Provider Enumeration Date:
05/12/2008