Provider First Line Business Practice Location Address:
1001 W 25TH AVE STE 2
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:
99203-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-263-0049
Provider Business Practice Location Address Fax Number:
509-624-0602
Provider Enumeration Date:
11/10/2010