Provider First Line Business Practice Location Address:
8514 S SAGEWOOD RD
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:
99223-9271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-443-1187
Provider Business Practice Location Address Fax Number:
509-448-1328
Provider Enumeration Date:
10/31/2005