Provider First Line Business Practice Location Address:
1502 N VERCLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-462-6577
Provider Business Practice Location Address Fax Number:
509-434-1995
Provider Enumeration Date:
02/23/2012