Provider First Line Business Practice Location Address:
12525 E MISSION AVE
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-5661
Provider Business Practice Location Address Fax Number:
509-891-6302
Provider Enumeration Date:
12/12/2007