Provider First Line Business Practice Location Address:
14603 E 24TH AVE
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:
99037-9343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-228-4645
Provider Business Practice Location Address Fax Number:
509-228-4609
Provider Enumeration Date:
04/21/2014