Provider First Line Business Practice Location Address:
104 S FREYA ST STE 127
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:
99202-4881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-534-4600
Provider Business Practice Location Address Fax Number:
509-533-6334
Provider Enumeration Date:
07/26/2007