Provider First Line Business Practice Location Address:
8117 N DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-5765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-9335
Provider Business Practice Location Address Fax Number:
509-466-9121
Provider Enumeration Date:
11/02/2007