Provider First Line Business Practice Location Address:
801 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 518
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-3147
Provider Business Practice Location Address Fax Number:
509-747-0020
Provider Enumeration Date:
08/25/2006