Provider First Line Business Practice Location Address:
5901 N LIDGERWOOD ST
Provider Second Line Business Practice Location Address:
STE 25B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-5019
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006