Provider First Line Business Practice Location Address:
221 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
APT 24
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-0162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-389-3473
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2006