Provider First Line Business Practice Location Address:
820 S MCCLELLAN ST
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-3147
Provider Business Practice Location Address Fax Number:
509-747-0020
Provider Enumeration Date:
08/25/2006