Provider First Line Business Practice Location Address:
5904 N DIVISION ST
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:
99208-1026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-1150
Provider Business Practice Location Address Fax Number:
509-482-6010
Provider Enumeration Date:
11/16/2005