Provider First Line Business Practice Location Address:
1105 N LINCOLN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-252-9891
Provider Business Practice Location Address Fax Number:
509-838-7503
Provider Enumeration Date:
11/11/2011