Provider First Line Business Practice Location Address:
25 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-4601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-1582
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2013