Provider First Line Business Practice Location Address:
5901 N LIDGERWOOD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-5733
Provider Business Practice Location Address Fax Number:
509-327-5191
Provider Enumeration Date:
08/31/2006