Provider First Line Business Practice Location Address:
509 N SULLIVAN RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-8565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-8005
Provider Business Practice Location Address Fax Number:
509-327-7869
Provider Enumeration Date:
10/02/2007