Provider First Line Business Practice Location Address:
316 W BOONE AVE
Provider Second Line Business Practice Location Address:
SUITE 656
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-242-7202
Provider Business Practice Location Address Fax Number:
509-593-4676
Provider Enumeration Date:
03/23/2012