Provider First Line Business Practice Location Address:
1410 N MULLAN RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-413-2482
Provider Business Practice Location Address Fax Number:
509-413-2385
Provider Enumeration Date:
09/06/2011