Provider First Line Business Practice Location Address:
1405 E 12TH 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:
99202-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-768-6852
Provider Business Practice Location Address Fax Number:
509-343-1623
Provider Enumeration Date:
09/17/2013