Provider First Line Business Practice Location Address:
15404 E SPRINGFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-8569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-892-9800
Provider Business Practice Location Address Fax Number:
509-892-9998
Provider Enumeration Date:
10/18/2010