Provider First Line Business Practice Location Address:
3209 E 57TH AVE STE F
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:
99223-7040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-448-9398
Provider Business Practice Location Address Fax Number:
509-315-8354
Provider Enumeration Date:
05/11/2009