Provider First Line Business Practice Location Address:
2607 S SOUTHEAST BLVD
Provider Second Line Business Practice Location Address:
SUITE A-203
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99223-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-990-7098
Provider Business Practice Location Address Fax Number:
509-448-9239
Provider Enumeration Date:
05/10/2010