Provider First Line Business Practice Location Address:
610 S SHERMAN ST STE 101
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:
99202-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-473-1010
Provider Business Practice Location Address Fax Number:
509-473-1012
Provider Enumeration Date:
09/01/2006