Provider First Line Business Practice Location Address:
17 E 8TH 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:
99202-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-474-5678
Provider Business Practice Location Address Fax Number:
509-624-1095
Provider Enumeration Date:
09/13/2005