Provider First Line Business Practice Location Address:
16201 E INDIANA AVE
Provider Second Line Business Practice Location Address:
STE 3100
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-8904
Provider Business Practice Location Address Fax Number:
509-344-3104
Provider Enumeration Date:
10/03/2006