Provider First Line Business Practice Location Address:
1625 W 4TH AVE
Provider Second Line Business Practice Location Address:
ST 200
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-5855
Provider Business Practice Location Address Fax Number:
509-838-5779
Provider Enumeration Date:
01/12/2007