Provider First Line Business Practice Location Address:
1124 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE LL2
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-994-6232
Provider Business Practice Location Address Fax Number:
509-484-2128
Provider Enumeration Date:
09/15/2010