Provider First Line Business Practice Location Address:
8606 N WALL ST STE 102
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:
99218-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-315-4943
Provider Business Practice Location Address Fax Number:
509-315-4992
Provider Enumeration Date:
10/24/2006