Provider First Line Business Practice Location Address:
104 S FREYA ST
Provider Second Line Business Practice Location Address:
LILAC FLAG BG SUITE 118
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:
509-536-2070
Provider Business Practice Location Address Fax Number:
509-534-9293
Provider Enumeration Date:
10/18/2006