Provider First Line Business Practice Location Address:
16609 E DESMET CT APT B405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-3552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-385-1290
Provider Business Practice Location Address Fax Number:
509-385-1290
Provider Enumeration Date:
10/12/2005