Provider First Line Business Practice Location Address:
507 N SULLIVAN RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-8535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-822-2774
Provider Business Practice Location Address Fax Number:
509-344-1113
Provider Enumeration Date:
09/15/2005