Provider First Line Business Practice Location Address:
1625 W 4TH AVE LOWR LEVEL200
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:
99201-5620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-560-4658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2012