Provider First Line Business Practice Location Address:
1601 S DISHMAN MICA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-3317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-389-5650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2008