Provider First Line Business Practice Location Address:
TAPIO PROFESSIONAL CENTER, GREEN FLAG BLDG 104 S. FREYA
Provider Second Line Business Practice Location Address:
SUITE 112C
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:
509-475-9924
Provider Business Practice Location Address Fax Number:
877-992-7014
Provider Enumeration Date:
11/06/2013