Provider First Line Business Practice Location Address:
13524 E SPRAGUE AVE STE 2
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:
99216-0888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-0991
Provider Business Practice Location Address Fax Number:
866-583-9296
Provider Enumeration Date:
05/20/2006