Provider First Line Business Practice Location Address:
3209 E 57TH AVE
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99223-7040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-868-0458
Provider Business Practice Location Address Fax Number:
509-868-0489
Provider Enumeration Date:
08/14/2009