Provider First Line Business Practice Location Address: 
140 S ARTHUR ST STE 408
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SPOKANE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
99202-2220
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-557-7776
    Provider Business Practice Location Address Fax Number: 
509-838-9683
    Provider Enumeration Date: 
05/10/2006