Provider First Line Business Practice Location Address:
5118 N ELM
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:
99201-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-263-4895
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2006