Provider First Line Business Practice Location Address:
105 W 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 170E
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-1228
Provider Business Practice Location Address Fax Number:
509-838-0277
Provider Enumeration Date:
05/26/2009