Provider First Line Business Practice Location Address:
1512 N VERCLER RD
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-921-6611
Provider Business Practice Location Address Fax Number:
509-921-6613
Provider Enumeration Date:
04/25/2006