Provider First Line Business Practice Location Address:
1717 S RUSTLE RD
Provider Second Line Business Practice Location Address:
SUITE 212A
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99224-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-315-4142
Provider Business Practice Location Address Fax Number:
509-242-0797
Provider Enumeration Date:
10/31/2006