Provider First Line Business Practice Location Address: 
105 W 8TH AVE
    Provider Second Line Business Practice Location Address: 
SUITE 6080
    Provider Business Practice Location Address City Name: 
SPOKANE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
99204-2313
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-838-6500
    Provider Business Practice Location Address Fax Number: 
509-838-6561
    Provider Enumeration Date: 
09/29/2009