Provider First Line Business Practice Location Address:
1208 W MALLON AVE
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:
99201-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-477-2427
Provider Business Practice Location Address Fax Number:
509-477-6460
Provider Enumeration Date:
11/06/2012