Provider First Line Business Practice Location Address:
S 104 FREYA #213A ORANGE FLAG BLDG
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:
99202-4868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-2552
Provider Business Practice Location Address Fax Number:
509-535-3345
Provider Enumeration Date:
04/26/2007