Provider First Line Business Practice Location Address:
5222 S MAGNOLIA 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:
99223-6529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-354-6350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2012