Provider First Line Business Practice Location Address:
122 E MONTGOMERY AVE STE D
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:
99207-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-342-3845
Provider Business Practice Location Address Fax Number:
509-624-0403
Provider Enumeration Date:
01/29/2018