Provider First Line Business Practice Location Address:
765 E HOLLAND AVE STE 3
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:
99218-1280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-824-1996
Provider Business Practice Location Address Fax Number:
509-684-5817
Provider Enumeration Date:
10/12/2005