Provider First Line Business Practice Location Address:
15923 E LONGFELLOW AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-4504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006