Provider First Line Business Practice Location Address:
502 E BOONE AVE
Provider Second Line Business Practice Location Address:
AD BOX 66
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99258-1774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-313-5591
Provider Business Practice Location Address Fax Number:
509-313-5789
Provider Enumeration Date:
01/25/2012