Provider First Line Business Practice Location Address:
2228 W WELLESLEY 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:
99205-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-981-7693
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2007