Provider First Line Business Practice Location Address:
59 E QUEEN AVE
Provider Second Line Business Practice Location Address:
SUITE 214 D
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-340-3588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2011