Provider First Line Business Practice Location Address:
539 W SHARP AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-0304
Provider Business Practice Location Address Fax Number:
509-462-0530
Provider Enumeration Date:
05/24/2007