Provider First Line Business Practice Location Address:
104 S FREYA ST STE 114
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:
509-325-4169
Provider Business Practice Location Address Fax Number:
509-325-4239
Provider Enumeration Date:
08/11/2011