Provider First Line Business Practice Location Address:
1119 W JOSEPH AVE
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:
99205-6649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-599-7316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2011