Provider First Line Business Practice Location Address:
9708 N NEVADA ST STE 203
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:
99218-6004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-863-9240
Provider Business Practice Location Address Fax Number:
509-574-5863
Provider Enumeration Date:
09/11/2009