Provider First Line Business Practice Location Address:
12406 E DESMET AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-2993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-0147
Provider Business Practice Location Address Fax Number:
509-688-0148
Provider Enumeration Date:
05/03/2007