Provider First Line Business Practice Location Address:
9922 N NEVADA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-6194
Provider Business Practice Location Address Fax Number:
509-838-0824
Provider Enumeration Date:
04/19/2007