Provider First Line Business Practice Location Address:
1414 W 14TH AVE
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:
99204-4020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-597-8757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2012