Provider First Line Business Practice Location Address:
605 E HOLLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-5001
Provider Business Practice Location Address Fax Number:
509-465-2326
Provider Enumeration Date:
04/23/2010