Provider First Line Business Practice Location Address:
101 W CASCADE WAY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-9638
Provider Business Practice Location Address Fax Number:
509-466-8381
Provider Enumeration Date:
08/12/2006