Provider First Line Business Practice Location Address:
1404 E. 11TH AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-744-1117
Provider Business Practice Location Address Fax Number:
509-744-3055
Provider Enumeration Date:
11/27/2013