Provider First Line Business Practice Location Address:
618 N SULLIVAN RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-8528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-3443
Provider Business Practice Location Address Fax Number:
509-891-5591
Provider Enumeration Date:
01/06/2006