Provider First Line Business Practice Location Address:
15320 E MARIETTA AVE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-5640
Provider Business Practice Location Address Fax Number:
509-927-4682
Provider Enumeration Date:
03/20/2006