Provider First Line Business Practice Location Address:
100 N HOWARD ST # 5684
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:
99201-0508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-972-9988
Provider Business Practice Location Address Fax Number:
877-552-0981
Provider Enumeration Date:
03/31/2012