Provider First Line Business Practice Location Address:
1312 N MONROE ST STE 139
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:
99201-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-855-8261
Provider Business Practice Location Address Fax Number:
509-744-3055
Provider Enumeration Date:
02/12/2008