Provider First Line Business Practice Location Address:
3325 S BERNARD ST
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:
99203-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-410-9908
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2013