Provider First Line Business Practice Location Address:
5633 N LIDGERWOOD ST
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:
99208-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-868-0876
Provider Business Practice Location Address Fax Number:
509-385-0670
Provider Enumeration Date:
03/27/2013