Provider First Line Business Practice Location Address:
210 W SPRAGUE 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:
99201-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-343-5072
Provider Business Practice Location Address Fax Number:
509-747-0609
Provider Enumeration Date:
05/27/2005