Provider First Line Business Practice Location Address:
111 E LINCOLN RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-6901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-701-4320
Provider Business Practice Location Address Fax Number:
208-439-8277
Provider Enumeration Date:
12/05/2007