Provider First Line Business Practice Location Address:
601 S PARK RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-921-7818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2007