Provider First Line Business Practice Location Address:
309 E FARWELL RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-8210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-3879
Provider Business Practice Location Address Fax Number:
509-484-1823
Provider Enumeration Date:
03/19/2010