Provider First Line Business Practice Location Address:
3707 S GRAND BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99203-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-0279
Provider Business Practice Location Address Fax Number:
509-747-3220
Provider Enumeration Date:
04/07/2006