Provider First Line Business Practice Location Address:
820 S MCCLELLAN ST
Provider Second Line Business Practice Location Address:
SUITE 418
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-8783
Provider Business Practice Location Address Fax Number:
509-624-0626
Provider Enumeration Date:
08/12/2006