Provider First Line Business Practice Location Address:
405 E HARTSON AVE STE 2
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:
99202-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-879-6339
Provider Business Practice Location Address Fax Number:
509-847-1117
Provider Enumeration Date:
02/22/2015