Provider First Line Business Practice Location Address:
104 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 200W
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-4880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-2313
Provider Business Practice Location Address Fax Number:
509-459-0686
Provider Enumeration Date:
11/17/2005