Provider First Line Business Practice Location Address:
111 N VISTA RD STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VLY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99213-0030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-236-1420
Provider Business Practice Location Address Fax Number:
509-512-8119
Provider Enumeration Date:
09/17/2012