Provider First Line Business Practice Location Address:
200 E 2ND AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-9385
Provider Business Practice Location Address Fax Number:
509-455-6831
Provider Enumeration Date:
06/13/2005