Provider First Line Business Practice Location Address:
421 W RIVERSIDE AVE STE 340
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:
99201-5092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-459-6455
Provider Business Practice Location Address Fax Number:
509-381-3538
Provider Enumeration Date:
12/30/2009