Provider First Line Business Practice Location Address:
9520 N NEWPORT HWY
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:
99218-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-7414
Provider Business Practice Location Address Fax Number:
509-466-0546
Provider Enumeration Date:
09/05/2013