Provider First Line Business Practice Location Address:
526 N MULLAN RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-3853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-924-2600
Provider Business Practice Location Address Fax Number:
509-926-9865
Provider Enumeration Date:
12/12/2006