Provider First Line Business Practice Location Address:
3223 E 57TH AVE STE I
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:
99223-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-7787
Provider Business Practice Location Address Fax Number:
509-535-5525
Provider Enumeration Date:
11/20/2006