Provider First Line Business Practice Location Address:
3010 S SOUTHEAST BLVD STE G
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:
99223-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-532-0500
Provider Business Practice Location Address Fax Number:
509-532-8810
Provider Enumeration Date:
09/26/2006