Provider First Line Business Practice Location Address:
200 N MULLAN RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-1688
Provider Business Practice Location Address Fax Number:
509-444-7038
Provider Enumeration Date:
07/31/2006