Provider First Line Business Practice Location Address:
4120 E 11TH AVE
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:
99202-5325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-532-8607
Provider Business Practice Location Address Fax Number:
509-927-7336
Provider Enumeration Date:
02/22/2007