Provider First Line Business Practice Location Address:
9502 N NEWPORT HWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-2243
Provider Business Practice Location Address Fax Number:
509-465-2269
Provider Enumeration Date:
01/16/2010