Provider First Line Business Practice Location Address:
10103 N DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-467-1156
Provider Business Practice Location Address Fax Number:
509-468-0462
Provider Enumeration Date:
09/06/2006