Provider First Line Business Practice Location Address:
3430 S GRAND BLVD
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:
99223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-270-1234
Provider Business Practice Location Address Fax Number:
509-448-3933
Provider Enumeration Date:
01/02/2007