Provider First Line Business Practice Location Address:
9505 N DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-9209
Provider Business Practice Location Address Fax Number:
509-466-6220
Provider Enumeration Date:
03/06/2007