Provider First Line Business Practice Location Address: 
4815 N ASSEMBLY ST
    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: 
99205-6185
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-434-7000
    Provider Business Practice Location Address Fax Number: 
509-434-7113
    Provider Enumeration Date: 
07/22/2006