Provider First Line Business Practice Location Address:
430 W 2ND AVE STE 101
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:
99201-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-220-1056
Provider Business Practice Location Address Fax Number:
509-459-3864
Provider Enumeration Date:
12/15/2006