Provider First Line Business Practice Location Address:
428 E 22ND AVE
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:
99203-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-443-9930
Provider Business Practice Location Address Fax Number:
509-747-0969
Provider Enumeration Date:
04/17/2007