Provider First Line Business Practice Location Address:
203 N EVERGREEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-0820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-994-4395
Provider Business Practice Location Address Fax Number:
509-207-7118
Provider Enumeration Date:
07/08/2006