Provider First Line Business Practice Location Address:
10103 N DIVISION STREET
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-467-1562
Provider Business Practice Location Address Fax Number:
509-467-1740
Provider Enumeration Date:
08/14/2006