Provider First Line Business Practice Location Address:
4100 S CHENEY SPOKANE RD STE B
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:
99224-5196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-5001
Provider Business Practice Location Address Fax Number:
509-919-3537
Provider Enumeration Date:
09/28/2006