Provider First Line Business Practice Location Address:
6417 N DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-6804
Provider Business Practice Location Address Fax Number:
509-466-9056
Provider Enumeration Date:
01/31/2008