Provider First Line Business Practice Location Address:
6604 S WANETA RD
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:
99223-6222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-251-1340
Provider Business Practice Location Address Fax Number:
208-606-0407
Provider Enumeration Date:
04/16/2007