Provider First Line Business Practice Location Address:
104 S FREYA ST STE 110D
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:
99202-4878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-726-1011
Provider Business Practice Location Address Fax Number:
509-844-0165
Provider Enumeration Date:
02/13/2007