Provider First Line Business Practice Location Address:
801 WEST FIFTH AVE
Provider Second Line Business Practice Location Address:
SUITE 509
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-473-3077
Provider Business Practice Location Address Fax Number:
509-473-3033
Provider Enumeration Date:
06/15/2005