Provider First Line Business Practice Location Address:
4915 S HELENA ST
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:
99223-8122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-270-4612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2012