Provider First Line Business Practice Location Address:
1403 S GRAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 204 SOUTH
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99203-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-414-5050
Provider Business Practice Location Address Fax Number:
509-414-5051
Provider Enumeration Date:
09/28/2010